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N a t i o n a l A s s o c i a t i o n o f S t a t e E M S O f f i c i a l s
w w w . n a s e m s o . o r g
2020 NATIONALEMERGENCY MEDICAL SERVICES
ASSESSMENT
2020 NATIONAL EMS ASSESSMENT
May 27, 2020 Page i
DISCLAIMER
This document was produced with support from the US Department of Transportation, National Highway Traffic Safety Administration (NHTSA), Office of Emergency Medical Services (OEMS) through cooperative agreement DTNH2216H00016.
The contents of this document are solely the responsibility of the authors and do not necessarily represent the official views of NHTSA.
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May 27, 2020 Page ii
TABLE OF CONTENTS Disclaimer ..................................................................................................................................................................................... i
Executive Summary ................................................................................................................................................................. iv
Introduction ................................................................................................................................................................................. v
Methodology .................................................................................................................................................... v
Definitions ..................................................................................................................................................... viii
EMS Organizations .................................................................................................................................................................... 1
Types of EMS Agencies .................................................................................................................................... 1
Number of EMS Agencies by Type ................................................................................................................. 16
Types of Vehicles ........................................................................................................................................... 26
Number of EMS Agencies by Level of Service ................................................................................................ 36
EMS Professionals .................................................................................................................................................................... 46
Licensed EMS Professionals ............................................................................................................................ 46
Medical Directors ............................................................................................................................................ 57
Age of EMS Professionals ............................................................................................................................... 61
Race of EMS Professionals ............................................................................................................................. 63
Gender of EMS Professionals ......................................................................................................................... 63
Criminal Background Checks .......................................................................................................................... 64
EMS Communications ............................................................................................................................................................. 67
Video Transmission ........................................................................................................................................ 67
Receive Electronic Patient Information ........................................................................................................... 69
Send PCR to Another Entity ............................................................................................................................ 71
EMS Response and Patient Care .......................................................................................................................................... 73
Agency Responses ......................................................................................................................................... 73
Patient Transports ........................................................................................................................................... 82
Patient Care Protocols ..................................................................................................................................... 88
Medication & Procedures Lists ........................................................................................................................ 90
Pediatric Safe Transport Devices .................................................................................................................... 93
EMS Information Systems ....................................................................................................................................................... 97
Submission Requirements .............................................................................................................................. 97
NEMSIS ......................................................................................................................................................... 108
Data Linkage/Sharing ................................................................................................................................... 120
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Public Health Surveillance ............................................................................................................................ 136
Benchmarking ............................................................................................................................................... 138
EMS Compass ............................................................................................................................................... 139
EMS Workforce Health and Safety ................................................................................................................................... 142
Health/Wellness Programs ........................................................................................................................... 142
Access to CISM Resources ............................................................................................................................ 144
Workforce Monitoring ................................................................................................................................... 147
EMS Funding .......................................................................................................................................................................... 152
State Funding Sources ................................................................................................................................... 152
Federal Funding Sources .............................................................................................................................. 166
EMS Disaster Preparedness ................................................................................................................................................ 184
Federal Disaster and Public Health Preparedness Program Participation ..................................................... 184
Exercises/Drills and Real Events .................................................................................................................. 191
Mass Casualty Event Protocols ..................................................................................................................... 196
Triage Systems ............................................................................................................................................. 198
Electronic Patient Tracking Systems .............................................................................................................. 204
Appendix A – Assessment Instrument .............................................................................................................................. 208
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EXECUTIVE SUMMARY
This National Emergency Medical Services (EMS) Assessment 2020 is the culmination of work begun in October 2018 and completed in March 2020. It updates our knowledge of the state of EMS systems in the United States first established in the 2011 National EMS Assessment.
Publication of this resource is one deliverable of a Cooperative Agreement between the National Association of State EMS Officials (NASEMSO) and the Office of EMS, National Highway Traffic Safety Administration, U.S. Department of Transportation (NHTSA).
The 2011 National EMS Assessment was commissioned by the Federal Interagency CommiQee on EMS (FICEMS) to describe EMS, EMS emergency preparedness, and 911 systems at the state and national levels using existing data sources. Through the current Cooperative Agreement, NASEMSO agreed to work with NHTSA to publish a 2020 National EMS Assessment using existing data sources. This was an effort to provide the most important or requested updates of the information provided by the 2011 project.
Fifty-four of 56 states and territories responded to the 61 question (and multiple sub-question) “snapshot” survey which produced the data included in this report.
The Assessment presents the data and analysis in the following categories, paralleling the 2011 project:
l EMS Organizations l EMS Professionals l EMS Communications l EMS Response and Patient Care l EMS Information Systems l EMS Workforce Health and Safety l EMS Funding l EMS Disaster Preparedness
A comparative analysis of the 2011 and 2020 data is not aQempted because those analyzing the laQer did not have access to definitional and analysis assumptions utilized in producing the former. The project effort concluded in March 2020, after which the Assessment was published on www.NASEMSO.org.
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INTRODUCTION
This National Emergency Medical Services (EMS) Assessment 2020 is the culmination of work begun in October 2018 and completed in March 2020. It updates our knowledge of the state of EMS systems in the United States first established in the 2011 National EMS Assessment.
The 2011 National EMS Assessment was commissioned by the Federal Interagency CommiQee on EMS (FICEMS) to describe EMS, EMS emergency preparedness, and 911 systems at the state and national levels using existing data sources. Through the current Cooperative Agreement, NASEMSO agreed to work with NHTSA to publish a 2020 National EMS Assessment using existing data sources. This was an effort to provide the most important or requested updates of the information provided by the 2011 project.
Specifically, NASEMSO:
l Produced an outline of potential national EMS assessment content in close consultation with NASEMSO leadership, NHTSA, and FICEMS representatives;
l Developed a data collection and analysis plan that identified potential EMS data sources; and l Published this 2020 National EMS Assessment.
Methodology
Outline of Potential National EMS Assessment Content
The NASEMSO team began the project in October 2018 with NHTSA project staff coordination meetings and by compiling a draft data point candidate list for the national EMS assessment content.
The project team began with data output cited in the Executive Summary of the 2011 National EMS Assessment Report (pp. x-xiii). A content matrix was constructed with the data point output/purpose, 2011 Assessment item original question and response list, and assigned 2020 National EMS Assessment draft item number. These represented the information areas from the 2011 Assessment report for which NASEMSO and NHTSA staff were aware of interest in updating. The draft list was delivered to NHTSA in November 2018 and was simultaneously subjected to review by the chairs of the five NASEMSO regions who served as the NASEMSO leadership steering group providing input to this project.
Subsequently, NHTSA project staff and the Federal Interagency CommiQee on EMS Technical Working Group (FICEMS) were engaged to review the draft outline of data point candidate content. Simultaneously, the NASEMSO team engaged the Association’s Board of Directors in a retreat discussion of the desired information to be achieved by the project and the best sources of that information. Included in these discussions were the need for an updating of definitions (e.g. EMS
2020 NATIONAL EMS ASSESSMENT
May 27, 2020 Page vi
licensure levels) to make them contemporary to 2020. The final potential national EMS assessment data point content outline was delivered to NHTSA in December 2018.
Data Collection, Analysis Plan, and 2020 National EMS Assessment Publication
A Data Collection and Analysis Plan was delivered to NHTSA in early 2019. It contained the following objectives. Their achievement methodology and subsequent outcome is described below.
1. Objective 1 – Create definitions of information sought, in contemporary terms, as suggested by the candidate data points and reviewers’ input. These should include, as applicable, standard data dictionary considerations, reporting specifications (including graphic reports to be used), and a survey tool to be used in the Snapshot Survey for those questions which will employ it.
With the guidance of the NASEMSO leadership steering group, the information matrix was expanded to create the definitions described.
2. Objective 2 – Evaluate the definitions resulting from Objective 1 against potential data sources for feasibility of collecting appropriate data, including the most recently available and complete data sets from the:
a. National EMS Information System (NEMSIS) National EMS Database b. EMS for Children (EMSC) Performance Measures Data c. National Registry of EMTs (NREMT) Longitudinal Emergency Medical Technician
AQributes and Demographics Study (LEADS) Database d. National Emergency Number Association (NENA) 9-1-1 Deployment Report System e. NASEMSO Domestic Preparedness CommiQee Survey Results f. NASEMSO 2020 EMS System Snapshot Survey Data
It was expected that the NASEMSO 2020 EMS System Snapshot Survey would be the primary data source as it was for the 2011 Assessment and would constitute a survey of state EMS offices for all data unavailable or not feasibly obtainable through the other sources listed above. The other sources were considered in discussions at the 2018 NASEMSO Board retreat, discussions with NHTSA/FICEMS staff, inquiries of those closest to the sources listed, and deliberations with the NASEMSO leadership steering group. The alternative sources were largely eliminated because they were not sufficiently inclusive of all states or did not adequately satisfy the definitions of the information sought. The interests represented by the data sources, however, were added to the list of reviewers of the System Snapshot Survey during its development.
3. Objective 3 - Request or otherwise collect data available through all sources to be used other than the 2020 Snapshot Survey.
These sources were ruled out as described above.
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4. Objective 4 – For all candidate data points, other than those for which data is being sought in Objective 3, create draft questions (replicating 2011 wording wherever practical) for Snapshot Survey, review draft questions with NASEMSO leadership steering group. Put in Survey tool. Test tool.
The assessment instrument was constructed in spring, 2019 based on definitions matrix of information desired and specific questions used in 2011. It was determined that the methodology of the 2011 Assessment data collection and analysis were not available to this project, so while the project staff would reasonably replicate 2011 questions, a comparative analysis was not intended. The instrument was distributed for review to the Data Managers and Pediatric Emergency Care Councils, NASEMSO Domestic Preparedness CommiQee, NEMSIS Technical Assistance Center staff, experts on NG911 and communications systems (e.g. APCO, NENA, the NHTSA National 911 Program), and NHTSA/FICEMS staff.
The assessment instrument went out at the end of March 2019.
5. Objective 5 – Using the leadership steering group, solicit at least three states in which to pilot the Snapshot Survey. Ideally, there will be one state from each region. Conduct pilot survey.
The draft survey tool was piloted in five of the state EMS offices of the NASEMSO Regional chairs or vice-chairs: Florida, Wyoming, Rhode Island, Idaho, and Michigan. Simultaneously, all state EMS offices were invited to review and comment on the draft survey instrument.
6. Objective 6 – Based on feedback from the pilot process, revise Snapshot Survey and distribute to state EMS offices.
The assessment instrument was distributed for completion to state EMS offices at the end of March 2019. It contained 61 questions, many with sub-questions, organized in the same eight sections as the 2011 Assessment (see Appendix A).
7. Objective 7 – Assure receipt of Objective 3 data. Analyze for acceptability.
The sources for this data were not utilized as described above.
8. Objective 8 – Assure receipt of Objective 6 data throughout reply period. Initial and repeat wriQen requests will be made, and then phone requests will follow at least twice.
This process experienced significant delay, with the last data item received in March 2020. Most of the data was received from April 2019 through December 2019. One additional survey was aQempted to clarify the data already received. Research and phone/email contacts were made of some two-thirds of respondents, many on multiple occasions, to clarify information received. The NHTSA agreement was extended to accommodate the delays encountered with a revised completion date of March 31, 2020.
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Fifty-four states (see definitions below) submiQed responses. American Samoa and Puerto Rico did not submit responses.
9. Objective 9 – Staff complete graphic and wriQen analyses of all data. Rough draft of Assessment distributed to leadership steering group for review.
This was completed in time for an extensive review of the draft at the December 2020 NASEMSO Executive CommiQee retreat.
10. Objective 10 – Draft Assessment delivered to NHTSA.
This was accomplished on the deadline of December 30, 2019.
11. Objective 11 – NHTSA/FICEMS comments returned.
All NHTSA/FICEMS comments were considered and changes integrated into the Assessment process and products as suggested.
12. Objective 12 – Final 2020 National EMS Assessment delivered to NHTSA and published on NASEMSO website.
Posted at www.NASEMSO.org in March 2020.
Definitions
The following definitions were employed in the survey instrument and this Assessment:
Community Paramedicine: The term “community paramedicine” is used in the context of EMS resources being used to meet non-emergency health care needs in a community. For the survey’s purpose, it includes mobile integrated healthcare, community EMS, community EMT, and other such names and services that may be found in the state.
EMS Professional: The term “EMS professional” is intended to mean anyone, volunteer or career, with an official EMS capacity to interact with patients and others within the EMS system and generally outside of healthcare facilities.
License: The term “license” and its variants are used. A “license” and “licensure” represents legal authority granted to an individual, agency, vehicle or other entity/thing by the state to perform, or with which to perform, certain restricted activities. This authority granted by the state is defined as licensure in this survey, acknowledging that some states still use “certification”, “permiQing” and perhaps other terms to describe the same granting of authority.
State: This term is used to encompass state, commonwealth, district, and territory as so refers to all respondents.
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EMS ORGANIZATIONS
Types of EMS Agencies
What types of ems agencies operate in your state, and who regulates them? (agencies that are based in your state)
Chart 1
6
1
20
10
17
1
1
4
2
1
1
2
2
2
1
1
1
19
6
24
1
3
2
1
12
32
12
50
47
45
50
EMD(n=54)
CP(n=54)
Non-Ambulance Transport(n=54)
Air Medical(n=54)
Ground Specialty Care(n=54)
911 w/o transport(n=54)
911 w/transport(n=54)
EMD(n=54)
CP(n=54)
Non-AmbulanceTransport(n=54)
Air Medical(n=54)
GroundSpecialty
Care(n=54)
911 w/otransport(n=54)
911w/transport
(n=54)
EMS Office 12 32 12 50 47 45 50Other State Agency 19 6 24 1 3 2 1Multiple State Agencies 1 0 0 0 1 0 1Other Entity 2 0 1 1 2 2 2Operate - Not Regulated 20 10 17 1 1 4 0Do Not Operate 0 6 0 1 0 1 0
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Analysis
Agencies that provide emergency medical services vary in the types of services provided (e.g. ground ambulance, air ambulance, non-transport first response) and state EMS offices vary in the types of regulatory oversight they administer for these services and agencies from state to state (e.g. some license ambulance agencies but not ambulance vehicles while others may do both).
The traditional common denominator of EMS in the public’s view, the ambulance agency that responds to 911 calls and transports emergency patients to hospitals (“911 Response (Scene) With Transport”), exists in every state and is solely regulated by the state EMS office in 50 (93%) of the states responding to the survey. In Colorado and California, county or other substate regional entities serve this purpose, while in Delaware different agencies regulate basic life support (BLS) and advanced life support (ALS) 911-responding ambulance services. In Ohio, the state EMS office regulates private services, but other more local mechanisms exist for regulating public (e.g. fire-based) ambulance services.
Definitions and Description
911 Response (Scene) without Transport Services that generally respond to the scene of a call before the ambulance can get there (e.g. a fire truck from a closer station), or services that bring personnel with more advanced care in certain circumstances. While these do not exist in South Dakota, “operate but are not regulated” in four states (9%) and have “other forms of EMS regulation” in four states (7%), they are regulated by state EMS offices in 44 states (81%).
Ground Specialty Care Services (e.g. interfacility, critical care, other transport) are ambulance services licensed by state EMS offices in 47 states (87%). They generally serve special purposes other than, or as well as, responding to 911 calls.
Air Medical Services (comprising both fixed-wing and helicopter services) are found in all but one responding state. The Federal Aviation Administration regulates these services as air service operators, while EMS regulators have purview over the medical aspects of the service. Fifty state EMS offices (93%) regulate these services. In California, again, they are regulated by county or other substate entities. In the remaining states they are either regulated by other EMS entities (two, or 4%) or not regulated by EMS (two, or 4%).
Non-Ambulance Medical Transport Services (e.g. wheelchair vans/ambuleTes) are services for people with special transportation needs who generally don’t require medical care or monitoring enroute. They are regulated by state EMS in only 12 states (22%). They are either unregulated or regulated by other entities in the remainder.
Community Paramedicine-Type (CP) Services are most often other EMS agencies that provide EMS personnel and other resources to help meet unmet health needs in their communities. This generally a specially trained EMT or paramedic who can provide certain kinds of preventive or other primary care. This may be offered between 911 calls or by dedicated CP staff on days that they are not
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staffing an emergency ambulance (other staffing methods exist as well). This is a fairly new concept, but it is already being offered in 48 of 54 states that responded to the survey (89%). State EMS offices regulate CP in 32 of the responding states (59%), while other agencies do so in six states (11%), and it is not governmentally regulated in 10 where it offered (19%).
Emergency Medical Dispatch (EMD) Center is included in this assessment because it constitutes a true provider of emergency medical service in the critical chain of response. Staff operating these centers and interacting with 911 callers seeking emergency medical response are generally trained and certified EMD professionals who can provide emergency medical assistance “over the phone” until other EMS professionals arrive in person. Nonetheless, the maturing of “dispatch centers” (general purpose 911 communications centers receiving police, fire and EMS calls and simply sending out responders) to serve this specialty medical purpose is still evolving in many places, as is the regulation of these centers. Only 12 state EMS offices (22%) regulate EMD, while state communications, public utility, and other agencies regulate EMD in 22 states (41%), and it is unregulated in 20 states (37%).
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911 RESPONSE (SCENE) WITH TRANSPORT (n=54)
Figure 1
C O M M E N T S
l EMS Office ¡ AK: Optional if they want to bill ¡ OH: Regulate private services; public
services not regulated ¡ GU: Guam Fire Department with
ambulance/ALS l Multiple State Agencies
¡ DE: We have both: EMS office regulates ALS and other state agency regulates BLS
l Other Entity ¡ CA: Regulated by regional (single or multi-
county) EMS authority ¡ CO: Ground ambulance services are regulated by the counties
Chart 2 50
1 1 2
EMSOffice
OtherState
Agency
MultipleState
Agencies
OtherEntity
COUNTOF
STATES
REGULATES
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May 27, 2020 Page 5
911 RESPONSE (SCENE) WITHOUT TRANSPORT (n=54)
Figure 2
Chart 3
44
2 1 2 41
EMS Office Other StateAgency
Mulltiple StateAgencies
Other Entity Operate,Not Regulated
Do NotOperate
COUNTOF
STATES
REGUALTES
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C O M M E N T S
l EMS Office ¡ NY: Regulate ALS non transport, but do not regulate BLS non transport agencies; however,
we do regulate any certified provider ¡ GA: Only regulate the Medical First Responder services licensed by the Department of
Public Health; Fire Departments not licensed by us still perform non-transport medical (basic only) responses
¡ AK: Optional if they want to bill ¡ AZ: Limited to only certification/scope of practice compliance ¡ DE: County ALS Services ¡ OH: Regulate private services; public services not regulate
l Other Entity ¡ CA: Regulated by regional (single or multi-county) EMS authority
l Operate – Not Regulated ¡ OR: Non-transporting EMS agencies not licensed by state; however, the EMS providers and
their respective supervising physicians are regulated ¡ MN: Voluntary registration with State Agency, 18 currently registered ¡ KS: Pursuing legislative ability to clearly regulate these entities
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GROUND SPECIALTY CARE SERVICES (E.G. INTERFACILITY, CRITICAL CARE, OTHER TRANSPORT) (n=54)
Figure 3
Chart 4
47
2 1 2 1
EMS Office OtherState Agency
MultipleState Agencies
Other Entity Operate,Not Regulated
COUNTOF
STATES
REGULATES
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May 27, 2020 Page 8
C O M M E N T S
l EMS Office ¡ AK: Optional ¡ MI: In the process of formalizing the critical care component ¡ OH: Regulate private services; public services not regulated
l Multiple State Agencies ¡ DE: EMS office regulates County ALS and Delaware State Police, and other state agency
regulates BLS l Other Entity
¡ CA: Regulated by regional (single or multi-county) EMS authority ¡ CO: Ground ambulance services regulated by the counties
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AIR MEDICAL SERVICES (n=54)
Figure 4
C O M M E N T S
l EMS Office ¡ OH: Regulate private services;
public services not regulated l Other Entity
¡ CA: Regulated by regional (single or multi-county) EMS authority
50
1 1 1 1
EMS Office OtherState
Agency
Other Entity Operate,Not
Regulated
Do NotOperate
COUNTOF
STATES
REGULATES
Chart 5
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May 27, 2020 Page 10
NON-AMBULANCE MEDICAL TRANSPORT (E.G. WHEELCHAIR VANS/AMBULETTES) (n=54)
Figure 5
Chart 6
12
25
1
16
EMS Office Other StateAgency
Other Entity Operate,Not Regulated
COUNTOF
STATES
REGULATES
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C O M M E N T S
l EMS Office ¡ CT: Invalid Coaches ¡ OH: Regulate private services; public services not regulated ¡ OK: Limited to Stretcher Vans
l Other State Agency ¡ VA: Regulated by the Virginia Department of Medical Assistance Services ¡ AK: There is an exception for transport services to sobering centers which use licensed
EMTs for which the EMS Office has some oversight. l Other Entity
¡ KS: These are regulated at the local ordinance level (are treated as public transportation, taxi, etc.).
l Operate – Not Regulated ¡ AZ: EMS Office, via A.R.S. 36-2223, oversees use restrictions of non-ambulance medical
transport vehicles. Arizona Department of Transportation issues vehicle licenses for these service providers.
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COMMUNITY PARAMEDICINE-TYPE (n=54)
Figure 6
Chart 7
32
610
6
EMS Office Other Agency Operate,Not Regulated
Do Not Operate
COUNTOF
STATES
REGULATES
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C O M M E N T S
l EMS Office ¡ CO: The Health Facilities and EMS Division issues Community Integrated Health Care
Service Agency licenses and Paramedic with Community Paramedicine endorsements; however, Community Assistance Referral and Education Services are unregulated.
¡ CT: legislation just passed - not yet implemented. ¡ HI: 2019 Hawaii Legislative Session passed ACT 140 allowing for community paramedicine
in Hawaii. Administrative rules are currently being drafted. ¡ IL: Not in rules but doing this as a pilot program. ¡ IN: New law and rules being promulgated effective July 1, 2019. ¡ MI: This is still in the special study stage and we are in the process for formalizing the CP
curriculum, standards, protocols, level of licensure for providers and agencies and working with payers.
¡ OH: Authority over medical direction and scope of practice ¡ VA: Some programs hold Home Healthcare Agency license as well. ¡ VT: We have several non-connected projects. Each is with an EMS agency that is licensed by
our office, but there are no formal rules for CP yet. l Other State Agency
¡ CA: Pilot Program only in 10 sites authorized temporarily by OSHPD. l Operate – Not Regulated
¡ AL: BLS non-transport only ¡ ND: We regulate the Paramedic, but not the CP. At this time we have very few in the state,
we are trying to capture numbers. The State of ND has very poor reimbursement for CPs, this is something that we are working on and feel is a very needed care field.
¡ OR: CP/MIH not explicitly regulated. If associated with a transporting agency, they would fall under licensing requirement and oversight.
l Do Not Operate ¡ GU: Currently in the process of paramedic certification.
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EMERGENCY MEDICAL DISPATCH (EMD) CENTER (n=54)
Figure 7
Chart 8
12
19
1 2
20
EMS Office OtherState Agency
MultipleState Agencies
Other entity Operate,Not Regulated
COUNTOF
STATES
REGULATES
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C O M M E N T S
l EMS Office ¡ HI: Four EMD centers operate in the State, one for each county. A fifth EMD center is
currently being built for interfacility transfers by the private ambulance agency but this center is not regulated by EMSIPSB.
l Other State Agency ¡ ND: State Radio deals with the actual dispatch center. We do provide an avenue for EMD
for dispatchers. ¡ WV: Enhanced EMD is now state legislated in WV State Code 24.
l Multiple Agencies ¡ NJ: Office of Emergency Telecommunications Centers provides some regulatory oversight,
with clinical categorization flipcharts designed by OEMS (Emergency Medical Controllers must be EMDs.) OEMS must inspect and explicitly approve Mobile Intensive Care and Mobile Aeromedical Care Communication Programs.
l Other Entity ¡ CA: Regulated by regional (single or multi-county) EMS authority ¡ OR: Regulated at the county level and DPSST
l Operate – Not Regulated ¡ MI: The State 911 Director has been added to the statutorily recognized advisory body to the
State EMS Office. This occurred through an executive order from the Governor's Office. ¡ VT: Although dispatch is regulated by Public Safety, there are no formal rules associated
with EMD.
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Number of EMS Agencies by Type
How many of the following agencies are currently licensed in your state? (indicate numbers for each type listed, with the understanding that an agency may be counted more than once if multiple licenses held) - 911 response (scene) with transport - 911 response (scene) without transport - Ground specialty care services (e.g. interfacility, critical care, other transport) - Air medical services - Non-ambulance medical transport (e.g. wheelchair vans/ambuleLes) - Community paramedicine-type - Emergency medical dispatch (EMD) center
Totals by State
Table 1
# of Responding
States Mean Median Min Max Total
54 431 336 5 2,024 23,272
Chart 9
5
8
11
15
11
4
5-21
64-126
155-285
300-500
550-925
1,195-2,025
COUNTOF
STATES
# OF LICENSED AGENCIES
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Figure 8
Table 2
State Total
Licensed Agencies
AK 93 AL 307
AR 218 AS No Response AZ 116
CA 923 CO 236 CT 485
DC 21 DE 87 FL 576
GA 424 GU 5 HI 13
State Total
Licensed Agencies
IA 765 ID 211 IL 1,645
IN 827 KS 366 KY 220 LA 128 MA 586
MD 103 ME 367 MI 784
MN 318 MO 302 MP 5
State Total
Licensed Agencies
MS 126 MT 264 NC 558
ND 403 NE 440 NH 353 NJ 775 NM 359
NV 168 NY 1,195 OH 456
OK 373 OR 493 PA 1,346
State Total
Licensed Agencies
PR No Response RI 67 SC 282
SD 156 TN 558 TX 2,024 UT 203 VA 720
VI 11 VT 178 WA 497
WI 767 WV 269
WY 96
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Totals by Type
Table 3
AGENCY TYPE # of
Responding States
Mean Median Min Max Total (%)
911 Response (scene) with Transport 54 212 153 1 1,100 11,450
(49%)
911 Response (scene) without transport 45 151 79 1 903 6,778
(29%)
Ground Specialty Care Services 40 50 13 1 594 1,988 (9%)
Air Medical Services 52 14 11 1 65 753 (3%)
Non-Ambulance Medical Transport 24 57 10 1 346 747
(3%)
Community Paramedicine-Type 18 8 6 1 25 146 (1%)
Emergency Medical Dispatch (EMD) Center 24 56 29 1 248 1,410
(6%)
GRAND TOTAL 23,272
Analysis
The Grand Total of 23,272 agencies represents a ballpark figure that is consistent with other estimates but is impacted by differing definitions and licensing practices in states. Louisiana, American Samoa, and Puerto Rico are the missing in this count. Ambulance, first response, and air medical agencies that are typical EMS 911 responders comprise 18,981 (82%) of the overall agencies documented. Agencies that provide interfacility/specialty ground transport are 1,988 (9%) of the total. Many 911 responding ambulances serve in this capacity as well.
The survey question itself recognizes that one EMS agency may operate and be licensed for multiple services (e.g. “911 Response (Scene) with Transport” and “Air Medical Service”) and appear to be multiple agencies (while, in another state, that agency might have but one license and appear to be one agency).
Some states issue licenses for each county, ambulance base or jurisdiction in which an EMS agency operates. Others may issue one license per agency regardless of how many places that agency bases its equipment and staff and how many jurisdictions it serves. Some states do not license certain types of agencies (e.g. “911 Response (Scene) Without Transport”) though the agencies operate in the state. Some states do not license certain types of agency providers (e.g. Ohio licenses only private operators
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and not public agencies). An “Air Medical Service” may operate in some states where they are not specifically licensed or may receive one license in some states or one license per base in others. “Community paramedicine” exists in the vast majority of states yet agencies may not operate as CP agencies, state licensed or otherwise (and appear as “None” in those states). Some states license, or otherwise allow, CP practitioners to care for patients without licensing the EMS agency they work for as a “CP agency”.
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911 RESPONSE (SCENE) WITH TRANSPORT (n=53)
Table 4
AGENCY TYPE # of
Responding States
Mean Median Min Max Total (%)
911 Response (scene) with Transport 54 212 153 1 1,100 11,450
(49%)
Chart 10
Figure 9
6
129 9 9
63
1-27 51-100 101-150 151-200 215-350 370-600 750-1100
COUNTOF
STATES
# OF LICENSED AGENCIES
2020 NATIONAL EMS ASSESSMENT – EMS ORGANIZATIONS
May 27, 2020 Page 20
911 RESPONSE (SCENE) WITHOUT TRANSPORT (n=45)
Table 5
AGENCY TYPE # of
Responding States
Mean Median Min Max Total (%)
911 Response (scene) without transport 45 151 79 1 903 6,778
(29%)
Chart 11
Figure 10
96
129
7
2
1-10 11-50 55-100 110-215 325-505 550-905COUNTOF
STATES
# OF LICENSED AGENCIES
2020 NATIONAL EMS ASSESSMENT – EMS ORGANIZATIONS
May 27, 2020 Page 21
GROUND SPECIALTY CARE SERVICES (n=40)
Table 6
AGENCY TYPE # of
Responding States
Mean Median Min Max Total (%)
Ground Specialty Care Services 40 50 13 1 594 1,988 (9%)
Chart 12
Figure 11
19
7 64
2 2
1-10 11-30 31-50 51-100 101-200 350-600
COUNTOF
STATES
# OF LICENSED AGENCIES
2020 NATIONAL EMS ASSESSMENT – EMS ORGANIZATIONS
May 27, 2020 Page 22
AIR MEDICAL SERVICES (n=51)
Table 7
AGENCY TYPE # of
Responding States
Mean Median Min Max Total (%)
Air Medical Services 52 14 11 1 65 753 (3%)
Chart 13
Figure 12
1412
19
6
1
1-5 6-10 11-25 30-50 65
COUNTOF
STATES
# OF LICENSED AGENCIES
2020 NATIONAL EMS ASSESSMENT – EMS ORGANIZATIONS
May 27, 2020 Page 23
NON-AMBULANCE MEDICAL TRANSPORT (n=13)
Table 8
AGENCY TYPE # of
Responding States
Mean Median Min Max Total (%)
Non-Ambulance Medical Transport 13 57 10 1 346 747 (3%)
Chart 14
Figure 13
7
42
1-10 11-25 350
COUNTOF
STATES
# OF LICENSED AGENCIES
2020 NATIONAL EMS ASSESSMENT – EMS ORGANIZATIONS
May 27, 2020 Page 24
COMMUNITY PARAMEDICINE TYPE (n=18)
Table 9
AGENCY TYPE # of
Responding States
Mean Median Min Max Total (%)
Community Paramedicine-Type 18 8 6 1 25 146 (1%)
Chart 15
Figure 14
86
4
1-5 6-10 11-25COUNTOF
STATES
# OF LICENSED AGENCIES
2020 NATIONAL EMS ASSESSMENT – EMS ORGANIZATIONS
May 27, 2020 Page 25
EMERGENCY MEDICAL DISPATCH (EMD) CENTER (n=25)
Table 10
AGENCY TYPE # of
Responding States
Mean Median Min Max Total (%)
Emergency Medical Dispatch (EMD) Center 25 56 29 1 248 1,410
(6%)
Chart 16
Figure 15
9 8
3 3 2
1-10 11-55 56-100 120-180 200-250COUNTOF
STATES
# OF LICENSED AGENCIES
2020 NATIONAL EMS ASSESSMENT – EMS ORGANIZATIONS
May 27, 2020 Page 26
Types of Vehicles
How many of the following types of vehicles operate in your state, whether your office regulates them or not? (count of vehicles that are based in your state) - 911 response (scene) with transport - 911 response (scene) without transport - Ground specialty care services (e.g. interfacility, critical care, other transport) - Air medical services (rotor-wing) - Air medical services (fixed wing) - Non-ambulance medical transport (e.g. wheelchair vans/ambuleLes) - Community paramedicine-type
Totals by State
Table 11
State Total # of Vehicles
AK 700 AL 1,521 AR 718 AS No Response AZ 1,114 CA 5,057 CO 1,049 CT 1,225 DC 290 DE 308 FL 6,155 GA 3,591 GU 32 HI 148
State Total # of Vehicles
IA Unknown ID 728 IL 5,535 IN 2,384 KS 1,876 KY 1,196 LA Unknown MA 4,021 MD 1,899 ME 527 MI 3,491 MN 761 MO 1,241
MP 11
State Total # of Vehicles
MS 924 MT 413 NC 52 ND 473 NE Unknown NH 557 NJ 1,415 NM 73 NV 951 NY 5,014 OH 3,338 OK 867 OR 667 PA 4,548
State Total # of Vehicles
PR No Response RI 345 SC 2,358 SD 379 TN 1,604 TX 5,245 UT 439 VA 7,170 VI 63 VT 236 WA 3,049 WI 1,272 WV 523 WY 230
2020 NATIONAL EMS ASSESSMENT – EMS ORGANIZATIONS
May 27, 2020 Page 27
Totals by Type
Table 12
VEHICLE TYPE # of
Responding States
Mean Median Min Max Total (%)
911 Response (scene) with Transport 48 1,131 710 4 4,971 54,284
(62%)
911 Response (scene) without Transport 33 582 240 4 2,360 19,191
(22%)
Ground Specialty Care Services 31 155 27 1 2,615 4,795 (5%)
Air Medical Services (rotor-wing) 48 33 22 1 125 1,578 (2%)
Air Medical Services (fixed-wing) 38 18 9 1 101 679 (1%)
Non-Ambulance Medical Transport 11 241 45 2 1,709 2,656
(3%)
Community Paramedicine-Type 12 13 5 1 80 154 (.2%)
Unable to Breakdown by Type 1 4,490 (5%)
GRAND TOTAL 87,781
Analysis
The Grand Total of 87,781 EMS vehicles in operation whether licensed by a state EMS or not does not include numbers in American Samoa, Iowa, Louisiana, Nebraska, or Puerto Rico. Vehicles in Pennsylvania could not be broken out by type. The numbers for ambulance vehicles and air medical service vehicles are the least subject to interpretation. Even state EMS offices that do not regulate certain types of ambulance service are likely to be able to estimate the numbers of agencies and vehicles in these categories. The total of “911 Response (Scene) with Transport” (i.e. ambulances) is 54,284 is consistent with other estimates. The total of 1,578 air medical service rotorcraft is subject to interpretation of where aircraft are primarily based since many move among bases in different states. Nonetheless, the number approximates (understanding this likely duplication) the Atlas & Database of Air Medical Services (ADAMS) Rotor Wing Aircraft by Make and Model (ADAMS) 2019 figure of 1,115 rotorcraft.1
1 hTp://www.adamsairmed.org/pubs/rw_make_model_in_ADAMS_multi_year.pdf
2020 NATIONAL EMS ASSESSMENT – EMS ORGANIZATIONS
May 27, 2020 Page 28
Vehicles used by “911 Response (Scene) without Transport” agencies present more complexity. Many of these agencies are not licensed by state EMS offices, and many use a variety of multi-purpose vehicles (e.g. fire trucks, fly cars/utility vehicles, privately owned cars of volunteers) to respond to medical 911 calls.
The remaining vehicle types are even more subject to the vagaries of definition, ownership and responsibility for licensing as EMS vehicles. Ground Specialty Care vehicles are often lumped into “911 Response (Scene) With Transport” (i.e. ambulance type vehicles). This was specifically noted to have occurred in Minnesota, Missouri, North Dakota (which noted that all ambulances can be used for interfacility purposes), Nevada, New York, and Wisconsin.
2020 NATIONAL EMS ASSESSMENT – EMS ORGANIZATIONS
May 27, 2020 Page 29
911 RESPONSE (SCENE) WITH TRANSPORT (n=48)
Table 13
VEHICLE TYPE # of
Responding States
Mean Median Min Max Total (%)
911 Response (scene) with Transport 48 1,131 710 4 4,971 54,284
(62%)
Chart 17
Figure 16
9 11 10 117
1-250
251-500
615-975
1,025-2,000
3,700-5,000
COUNTOF
STATES
# OF VEHICLES
2020 NATIONAL EMS ASSESSMENT – EMS ORGANIZATIONS
May 27, 2020 Page 30
911 RESPONSE (SCENE) WITHOUT TRANSPORT (n=33)
Table 14
VEHICLE TYPE # of
Responding States
Mean Median Min Max Total (%)
911 Response (scene) without Transport 33 582 240 4 2,360 19,191
(22%)
Chart 18
Figure 17
11
64 5
7
1-100
125-250
251-399
400-1,100
1,475-2,360CO
UNTOF
STATES
# OF VEHICLES
2020 NATIONAL EMS ASSESSMENT – EMS ORGANIZATIONS
May 27, 2020 Page 31
GROUND SPECIALTY CARE SERVICES (E.G., INTERFACILITY, CRITICAL CARE, OTHER TRANSPORT) (n=31)
Table 15
VEHICLE TYPE # of
Responding States
Mean Median Min Max Total (%)
Ground Specialty Care Services 31 155 27 1 2,615 4,795 (5%)
Chart 19
Figure 18
9 106
3 2 1
1-10
11-50
51-100
101-200
375-615
2,615
COUNTOF
STATES
# OF VEHICLES
2020 NATIONAL EMS ASSESSMENT – EMS ORGANIZATIONS
May 27, 2020 Page 32
AIR MEDICAL SERVICES (ROTOR-WING) (n=48)
Table 16
VEHICLE TYPE # of
Responding States
Mean Median Min Max Total (%)
Air Medical Services (rotor-wing) 48 33 22 1 125 1,578 (2%)
Chart 20
Figure 19
1411
15
8
1-10 11-25 26-60 61-125COUNTOF
STATES
# OF VEHICLES
2020 NATIONAL EMS ASSESSMENT – EMS ORGANIZATIONS
May 27, 2020 Page 33
AIR MEDICAL SERVICES (FIXED-WING) (n=38)
Table 17
VEHICLE TYPE # of
Responding States
Mean Median Min Max Total (%)
Air Medical Services (fixed-wing) 38 18 9 1 101 677 (1%)
Chart 21
Figure 20
129 8
63
1-5 6-10 11-15 20-55 56-101
COUNTOF
STATES
# OF VEHICLES
2020 NATIONAL EMS ASSESSMENT – EMS ORGANIZATIONS
May 27, 2020 Page 34
NON-AMBULANCE MEDICAL TRANSPORT (n=11)
Table 18
VEHICLE TYPE # of
Responding States
Mean Median Min Max Total (%)
Non-Ambulance Medical Transport 11 241 45 2 1,709 2,656 (3%)
Chart 22
Figure 21
43
21 1
1-15 20-60 100-200 500 1,709COUNTOF
STATES
# OF VEHICLES
2020 NATIONAL EMS ASSESSMENT – EMS ORGANIZATIONS
May 27, 2020 Page 35
COMMUNITY PARAMEDICINE-TYPE (n=12)
Table 19
VEHICLE TYPE # of
Responding States
Mean Median Min Max Total (%)
Community Paramedicine-Type 12 13 5 1 80 154 (.2%)
Chart 23
Figure 22
6
4
1 1
1-5 6-10 25 80
COUNTOF
STATES
# OF VEHICLES
2020 NATIONAL EMS ASSESSMENT – EMS ORGANIZATIONS
May 27, 2020 Page 36
Number of EMS Agencies by Level of Service
Indicate how many EMS agencies are currently licensed in your state for the following service levels: - Emergency medical responder - Emergency medical technician - Advanced emergency medical technician - Other level between emergency medical technician and paramedic - Paramedic - Above or in addition to paramedic (e.g. a specialty license or endorsement)
Totals by Type
Table 20
AGENCY TYPE # of
Responding States
Mean Median Min Max Total (%)
Emergency Medical Responder (EMR) 20 174 62 1 623 3,487
(18%)
Emergency Medical Technician (EMT) 39 116 54 1 724 4,535
(23%)
Advanced Emergency Medical Technician (AEMT) 26 24 31 1 121 630
(3%)
Other Level Between EMT & Paramedic (excluding AEMT) 12 56 20 5 273 667
(3%)
Paramedic 37 177 101 1 1,609 6,532 (33%)
Above or in Addition to Paramedic 20 24 15 1 83 484 (2%)
Agencies not Licensed by Level/ Type of Care 12 290 249 135 587
3,185 (16%)
GRAND TOTAL 54 19,520
Analysis
The Grand Total of 19,520 agencies is consistent with the figure discussed above for agencies categorized functionally as 911 responders with and without transport, air medical services and interfacility/ground specialty services (approximately 21,000). A comparison of number of agencies by function (e.g. 911 response without transport) and level (e.g. emergency medical responder) is tempting but ultimately not informative.
2020 NATIONAL EMS ASSESSMENT – EMS ORGANIZATIONS
May 27, 2020 Page 37
It is also tempting to correlate the percentages of basic life support and advanced life support agencies with the level of care received by the average American (e.g. 18% of the agencies are emergency medical technician while 39% are advanced EMT or paramedic, so one is likelier to get advanced care than basic care). Unfortunately, this does not account for the actual distribution of those services (e.g. by urban versus rural areas, with basic care more likely in the laQer) nor the meaning of the license designation. In some states an agency must license at the level at which it guarantees that level to be provided on all 911 calls but can provide a higher level when it is so staffed. In that case, the level of care in a state may be understated.
At least 16% of the agencies documented are in states that do not license by a level of care, or simply designate advanced life support versus basic life support.
2020 NATIONAL EMS ASSESSMENT – EMS ORGANIZATIONS
May 27, 2020 Page 38
EMERGENCY MEDICAL RESPONDER (n=20)
Table 21
AGENCY TYPE # of
Responding States
Mean Median Min Max Total (%)
Emergency Medical Responder 20 174 62 1 623 3,487 (18%)
Chart 24
Figure 23
57
4 4
1-7 20-80 200-350 415-625COUNTOF
STATES
# OF LICENSED AGENCIES
2020 NATIONAL EMS ASSESSMENT – EMS ORGANIZATIONS
May 27, 2020 Page 39
EMERGENCY MEDICAL TECHNICIAN (n=39)
Table 22
AGENCY TYPE # of
Responding States
Mean Median Min Max Total (%)
Emergency Medical Technician 39 116 54 1 724 4,535 (23%)
C O M M E N T S
l NJ: Volunteer services which do not bill are not required to be licensed.
Figure 24
13
8 9
4 41
1-20 21-65 90-150 151-275 325-450 725COUNTOF
STATES
# OF LICENSED AGENCIES
Chart 25
2020 NATIONAL EMS ASSESSMENT – EMS ORGANIZATIONS
May 27, 2020 Page 40
ADVANCED EMERGENCY MEDICAL TECHNICIAN (n=26)
Table 23
AGENCY TYPE # of
Responding States
Mean Median Min Max Total (%)
Advanced Emergency Medical Technician 26 24 13 1 121 630
(3%)
Chart 26
Figure 25
98 8
1
1-5 6-20 21-75 121
COUNTOF
STATES
# OF LICENSED AGENCIES
2020 NATIONAL EMS ASSESSMENT – EMS ORGANIZATIONS
May 27, 2020 Page 41
OTHER LEVEL BETWEEN EMT & PARAMEDIC (I.E., EXCLUDING AEMT) (n=12)
Table 24
AGENCY TYPE # of
Responding States
Mean Median Min Max Total (%)
Other Level Between EMT & Paramedic 12 56 30 1 273 667 (3%)
Chart 27
Figure 26
54
12
1-20 25-40 75 140-275COUNTOF
STATES
# OF LICENSED AGENCIES
2020 NATIONAL EMS ASSESSMENT – EMS ORGANIZATIONS
May 27, 2020 Page 42
PARAMEDIC (n=37)
Table 25
AGENCY TYPE # of
Responding States
Mean Median Min Max Total (%)
Paramedic 37 177 101 1 1,609 6,532 (33%)
Chart 28
Figure 27
57 6 7
10
2
1-15
20-50
51-100
101-200
201-400
575-1,610
COUNTOF
STATES
# OF LICENSED AGENCIES
2020 NATIONAL EMS ASSESSMENT – EMS ORGANIZATIONS
May 27, 2020 Page 43
ABOVE (OR IN ADDITION TO) PARAMEDIC (n=20)
Table 26
AGENCY TYPE # of
Responding States
Mean Median Min Max Total (%)
Above (or in addition to) Paramedic 20 24 15 1 83 484
(2%)
Chart 29
Figure 28
8
57
1-10 11-30 30-85COUNTOF
STATES
# OF LICENSED AGENCIES
2020 NATIONAL EMS ASSESSMENT – EMS ORGANIZATIONS
May 27, 2020 Page 44
AGENCIES NOT LICENSED BY LEVEL/TYPE OF CARE (n=12)
Table 27
AGENCY TYPE # of
Responding States
Mean Median Min Max Total (%)
Agencies not Licensed by Level/ Type of Care 12 290 249 135 587
3,185 (16%)
Figure 29
C O M M E N T S
l AZ: 2 BLS agencies, 93 ALS agencies (ambulance), 56 first responder l CO: The counties license ground ambulance services as BLS or ALS. There are 242 agencies in
their consolidated agency list but no ALS/BLS designation. l KS: Our agencies are not licensed by level but declare a percentage that they have ALS
capability.
2020 NATIONAL EMS ASSESSMENT – EMS ORGANIZATIONS
May 27, 2020 Page 45
l MO: We only license a service as Ground (217), Air (14 services, four times that in bases), or Non-transporting ALS (14).
l NE: Agencies are licensed as BLS (324) or ALS (97) services. l NH: Only the ambulances are licensed to a certain "level". Agencies are licensed by Transport vs
Non-transport. l NJ: 2 Physician Response Programs operating 9 vehicles (6 MONOC/NBI, 2 Cooper, 1 St
Joseph's Medical Director) l OR: Do not license EMS transporting agencies by service level (127 transport agencies and 31
non-transport agencies) l SD: Have one licensure status (128 instate ground ambulance services; 7 instate air ambulance
services l TX: 21 industrial l VA: EMS agencies are licensed by service (BLS, ALS, HEMS, Neonatal) not provider level.
2020 NATIONAL EMS ASSESSMENT – EMS PROFESSIONALS
May 27, 2020 Page 46
EMS PROFESSIONALS
Licensed EMS Professionals
Indicate how many of the following EMS professionals are licensed in your state. - Emergency medical responder - Emergency medical technician - Advanced emergency medical technician - Other level between emergency medical technician and paramedic - Paramedic - Above or in addition to paramedic (e.g. a specialty license or endorsement) - Emergency medical dispatcher (or 911 telecommunicators with EMD ability
Totals by State
Table 28
# of Responding
States Mean Median Min Max Total
54 19,497 12,129 110 91,236 1,052,842
Chart 30
3
11
9
7
12
7
5
110-270
2,800-4,860
5,300-9,660
10,180-13,130
16,520-25,550
29,700-42,100
54,500-91,300
COUNTOF
STATES
# OF LICENSED PROFESSIONALS
2020 NATIONAL EMS ASSESSMENT – EMS PROFESSIONALS
May 27, 2020 Page 47
Figure 30
Table 29
State Total # of
EMS Professionals
AK 4,022 AL 12,062 AR 7,379 AS No Response AZ 18,904 CA 91,236 CO 19,076 CT 23,264 DC 4,737 DE 3,308 FL 82,079 GA 21,443
State Total # of
EMS Professionals
GU 267 HI 3,363 IA 12,195 ID 4,850 IL 54,527 IN 24,605 KS 9,660 KY 13,130 LA 25,478 MA 39,828 MD 20,426 ME 5,573
State Total # of
EMS Professionals
MI 22,884 MN 29,763 MO 18,559 MP 191 MS 3,424 MT 4,855 NC 41,032 ND 5,323 NE 7,196 NH 5,314 NJ 30,031 NM 7,804
State Total # of
EMS Professionals
NV 7,910 NY 60,970 OH 41,241 OK 11,139 OR 12,256 PA 42,099 PR No Response RI 4,396 SC 10,187 SD 3,321 TN 20,936 TX 67,081
2020 NATIONAL EMS ASSESSMENT – EMS PROFESSIONALS
May 27, 2020 Page 2
State Total # of
EMS Professionals
UT 10,184 VA 35,961
State Total # of
EMS Professionals
VI 110 VT 2,839
State Total # of
EMS Professionals
WA 16,523 WI 18,009
State Total # of
EMS Professionals
WV 6,119
WY 3,773
Totals by Level Table 30
LICENSE LEVEL # of
Responding States
Mean Median Min Max Total (%)
Emergency Medical Responder (EMR) 43 2,651 666 4 16,706
113,973 (11%)
Emergency Medical Technician (EMT) 54 10,808 5,791 50 63,522
583,608 (55%)
Advanced Emergency Medical Technician (AEMT) 43 914 322 12 7,232
39,294 (4%)
Other Level Between EMT & Paramedic (excluding AEMT) 21 840 345 10 5,495
17,634 (2%)
Paramedic 52 5,162 3,066 40 33,578 268,420
25%
Above (or in addition to) Paramedic 19 442 213 2 1,577
8,399 (1%)
Emergency Medical Dispatcher (EMD) 15 1,434 604 8 8,500
21,514 (2%)
GRAND TOTAL 1,052,842
2020 NATIONAL EMS ASSESSMENT – EMS PROFESSIONALS
May 27, 2020 Page 48
Analysis
The most commonly and consistently licensed EMS professionals are emergency medical technicians, advanced emergency medical technicians (including other levels between emergency medical technician and paramedic), and paramedics. A total of 855,674 of these professionals were identified. Emergency medical technicians constitute 63% of these, while 6% are advanced emergency medical technicians (including other levels between emergency medical technician and paramedic), and 31% are paramedics.
Emergency Medical Responders are licensed in some states and not in others. They are an important part of the care delivered by an EMS system, often providing significantly earlier, local intervention when ambulance arrival is delayed by distance, terrain and/or traffic.
Professionals licensed to provide advanced care above the level of emergency medical technician but below the paramedic level are today called “advanced emergency medical technicians” by national standard. Earlier national consensus included variants of this and of an “intermediate emergency medical technician” or “emergency medical technician-intermediate” (sometimes with “1985”/”1999” tags dating the origin and capabilities specified by those titles). Also include were variations of a “cardiac care technician” which usually denoted nearly paramedic capabilities. The table below which describes this category shows the variation by state still remaining in this licensure space.
Individuals licensed “Above or in Addition to Paramedic” also vary by type and requirements from state to state. Some states include other health professionals in the category, while many states have paramedic specializations such as critical care, tactical, flight, and community paramedics. Some states included EMS instructors in this category though this has no official clinical practice significance. National certification for some of these capabilities exist but are relatively new. As these capabilities above the paramedic level become beQer defined and certification standards are accepted for them, they can be beQer quantified.
There are accepted national standards for certification as an emergency medical dispatcher, the first line in emergency medical intervention and care. Standards and responsibility for licensure in states vary however.
2020 NATIONAL EMS ASSESSMENT – EMS PROFESSIONALS
May 27, 2020 Page 49
EMERGENCY MEDICAL RESPONDER (n=43)
Table 31
LICENSE LEVEL # of
Responding States
Mean Median Min Max Total (%)
Emergency Medical Responder (EMR) 43 2,651 666 4 16,706
113,973 (11%)
Chart 31
Figure 31
9 10 107
3 4
4-190
200-460
550-1,550
1,680-3,400
5,000-7,100
15,000-16,710CO
UNTOF
STATES
2020 NATIONAL EMS ASSESSMENT – EMS PROFESSIONALS
May 27, 2020 Page 50
EMERGENCY MEDICAL TECHNICIAN (n=54)
Table 32
LICENSE LEVEL # of
Responding States
Mean Median Min Max Total (%)
Emergency Medical Technician (EMT) 54 10,808 5,791 50 63,522
583,608 (55%)
Chart 32
Figure 32
3
13 14
58 7
4
50-250
1,460-3,000
3,100-6,000
6,150-9,650
11,500-14,600
18,850-30,000
34,200-63,550
COUNTOF
STATES
# OF LICENSED PROFESSIONALS
2020 NATIONAL EMS ASSESSMENT – EMS PROFESSIONALS
May 27, 2020 Page 51
ADVANCED EMERGENCY MEDICAL TECHNICIAN (n=43)
Table 33
LICENSE LEVEL # of
Responding States
Mean Median Min Max Total (%)
Advanced Emergency Medical Technician (AEMT) 43 914 322 12 7,232
39,294 (4%)
Chart 33
Figure 33
12 11 107
3
10-125
130-360
400-900
1,260-3,000
3,400-7,250CO
UNTOF
STATES
# OF LICENSED PROFESSIONALS
2020 NATIONAL EMS ASSESSMENT – EMS PROFESSIONALS
May 27, 2020 Page 52
OTHER LEVEL BETWEEN EMT & PARAMEDIC (EXCLUDING AEMT) (n=21)
Table 34
LICENSE LEVEL # of
Responding States
Mean Median Min Max Total (%)
Other Level Between EMT & Paramedic 21 840 345 10 5,495
17,634 (2%)
Chart 34
Figure 34
75
4 4
1
10-110
125-360
450-775
1,600-2,600
5,500
COUNTOF
STATES
# OF LICENSED PROFESSIONALS
2020 NATIONAL EMS ASSESSMENT – EMS PROFESSIONALS
May 27, 2020 Page 53
T Y P E S O F L E V E L S
Intermediate l AL: I-85* l AZ: I-99 l CO: I-99 l DC: EMT-I l GA: I-85 l ID: I-85* l IL: EMT-I l ND: I-85 & I-99 l NE: EMT-I l NM: Intermediates l OK: I-85 l SD: I-85 & I-99 l VA: I-99* l WY: IEMT
* Indicates they cannot renew at this level
Other l AK: EMT2 & EMT3 l GA: Cardiac Technician l MD: Cardiac Rescue Technician l RI: EMT-Cardiac l UT: EMT-IA l WI: EMT-I (slightly different scope) l WV: ACT (approximately 69 are
practicing or bridging to Paramedic)
2020 NATIONAL EMS ASSESSMENT – EMS PROFESSIONALS
May 27, 2020 Page 54
PARAMEDIC (n=52)
Table 35
LICENSE LEVEL # of
Responding States
Mean Median Min Max Total (%)
Paramedic 52 5,162 3,066 40 33,578 268,420
25%
Chart 35
Figure 35
1
1113 12
10
5
40 325-1,000
1,100-2,750
3,000-4,750
5,300-9,700
15,700-33,600CO
UNTOF
STATES
# OF LICENSED PROFESSIONALS
2020 NATIONAL EMS ASSESSMENT – EMS PROFESSIONALS
May 27, 2020 Page 55
ABOVE (OR IN ADDITION TO) PARAMEDIC (n=19)
Table 36
LICENSE LEVEL # of
Responding States
Mean Median Min Max Total (%)
Above (or in addition to) Paramedic 19 442 213 2 1,577
8,399 (1%)
Chart 36
Figure 36
45
43 3
2-42
56-131
213-463
631-891
1,227-1,577
COUNTOF
STATES
# OF LICENSED PROFESSIONALS
2020 NATIONAL EMS ASSESSMENT – EMS PROFESSIONALS
May 27, 2020 Page 56
EMERGENCY MEDICAL DISPATCHER (n=15)
Table 37
LICENSE LEVEL # of
Responding States
Mean Median Min Max Total (%)
Emergency Medical Dispatcher (EMD) 15 1,434 604 8 8,500
21,514 (2%)
Chart 37
Figure 37
3 34 4
1
8-85
180-300
550-850
1,100-3,120
8,500COUNTOF
STATES
# OF LICENSED PROFESSIONALS
2020 NATIONAL EMS ASSESSMENT – EMS PROFESSIONALS
May 27, 2020 Page 57
Medical Directors
Indicate how many of each of the following types of EMS medical director positions exist within your state: (count of positions, since one medical director may hold multiple positions)
Table 38
MEDICAL DIRECTOR TYPE # of
Responding States
Mean Median Min Max Total
Local Agency 41 228 105 1 1,291 9,348
EMS Region/Jurisdiction 23 15 7 1 99 334
State 48 1 1 1 2 50
ANALYSIS
Medical directors of EMS systems play a key role in clinical oversight and medical policy-se9ing. State EMS medical directors guide policy-se9ing and the general clinical practice of EMS professionals. They may lead a medical direction commi9ee comprising regional and/or local EMS medical directors. Regional and local medical directors oversee the clinical practices of agencies and personnel under their single or multiple agency jurisdiction, often providing training, quality review and permission to practice.
LOCAL AGENCY LEVEL (n=41)
Table 39
MEDICAL DIRECTOR TYPE
# of Responding
States Mean Median Min Max Total
Local Agency 41 228 105 1 1,291 9,348
Chart 38
911 11
5 5
1-50
51-100
101-225
226-400
625-1,300
COUNTOF
STATES
# OF LOCAL MEDICAL DIRECTORS
2020 NATIONAL EMS ASSESSMENT – EMS PROFESSIONALS
May 27, 2020 Page 58
C O M M E N T S
l MN: Each Ambulance Services has a Medical Director l OH: All agencies providing emergency medical services shall have a medical director, meeting
the requirements set forth in the Ohio Revised Code l OR: Local agencies recruit and engage their own medical directors l WA: Washington State has 1 Medical Program Director per County
Figure 38
2020 NATIONAL EMS ASSESSMENT – EMS PROFESSIONALS
May 27, 2020 Page 59
EMS REGION/JURISDICTION LEVEL (n=22)
Table 40
MEDICAL DIRECTOR TYPE
# of Responding
States Mean Median Min Max Total
EMS Region/Jurisdiction 22 13 7 1 99 275
C O M M E N T S
l MN: Some of the Regions have a consortium of Medical Directors
l IL: There are 62 EMS Systems and there is one EMS Medical Director for each EMS System that oversee medical care for that specific area
Figure 39
9 10
2 1
1-5 6-15 25-35 99
COUNTOF
STATES
# OF REGIONAL MEDICAL DIRECTORS
Chart 39
2020 NATIONAL EMS ASSESSMENT – EMS PROFESSIONALS
May 27, 2020 Page 60
STATE LEVEL (n=47)
Table 41
MEDICAL DIRECTOR TYPE
# of Responding
States Mean Median Min Max Total
State 47 1 1 1 2 50
The count of states above (n=47) does not include the four states identified in the map below (Figure 40) which have medical advisory commiQees (WA, KS, TX, ID), which function in lieu of a single state EMS medical director.
C O M M E N T S
l MN: We have a State Medical Director on our Board l NE: The state has one PMD as an advisory position l VI: The EMS agency, which handles 911 response
within the territory, is aQached to the Department of Health. The State Medical Director has direct oversight over both the DoH Agency and the agencies regulated by it.
Figure 40
44
3
1 2
COUNTOF
STATES
# OF STATE MEDICAL DIRECTORS
Chart 40
2020 NATIONAL EMS ASSESSMENT – EMS PROFESSIONALS
May 27, 2020 Page 61
Age of EMS Professionals
Approximately what percentage of EMS professionals fit within the following age groups?
Table 42
AGE GROUP # of
Responding States
Mean Median Min Max
<20 Years 27 2.1% 1.3% 0.3% 9.0%
20-29 Years 35 23.3% 24.4% 6.0% 40.0%
30-39 Years 35 28.3% 28.9% 18.4% 47.0%
40-49 Years 35 25.1% 24.0% 19.0% 50.0%
50-59 Years 34 16.0% 16.1% 9.7% 25.2%
60-69 Years 34 5.9% 5.3% 1.0% 18.4%
70-79 Years 35 1.4% 1.0% 0.1% 5.3%
80-89 Years 15 0.5% 0.5% 0.03% 1.0%
>89 Years 4 1.1% 0.9% 0.01% 2.5%
Chart 41
1.9%
23.3%
28.3%25.1%
16.0%
5.9%
1.3% 0.3% 0.4%
<20 20-29 30-39 40-49 50-59 60-69 70-79 80-89 >89
MEAN
AGE GROUP
2020 NATIONAL EMS ASSESSMENT – EMS PROFESSIONALS
May 27, 2020 Page 62
Figure 41
Analysis
Licensee age distribution peaks around the 30 to 39 year-old range. Ten states entered total numbers, instead of percentages, which were converted to percentages.
8
19
4 5
20-29 30-39 40-49 Multiple
COUNTOF
STATES
AGE GROUP
Chart 42
2020 NATIONAL EMS ASSESSMENT – EMS PROFESSIONALS
May 27, 2020 Page 63
Race of EMS Professionals
Approximately what percentage of EMS professionals identify with the following race groups?
Table 43
RACE # of
Responding States
Mean Median Min Max
American Indian or Alaska Native 15 3.7% 2.0% 0.1% 10.5%
Asian, Black, or African American 18 14.0% 3.8% 0.5% 98%
White 18 50.7% 53.9% 2.0% 91.4%
Other 18 16.4% 5.9% 1.0% 100%
Analysis
Only a small number of states were able to identify this characteristic of the work force, perhaps because of changing licensure demographic information practices.
Gender of EMS Professionals
Approximately what percentage of EMS professionals are (in each gender category):
Table 44
GENDER # of
Responding States
Mean Median Min Max
Male 30 72.1% 72.6% 30.0% 99.0%
Female 30 27.0% 26.8% 1.0% 70.0%
Other 3 0.9% 0.4% 0.01% 2.3%
Analysis
States with males at 75% or more included Guam, Kentucky, Indiana, Michigan, Mississippi, Arkansas, Georgia, Florida, Arizona, Rhode Island, and Alabama. The Virgin Islands are the only state/territory to have more females than males in the EMS professional workforce. Some states reporting whole numbers rather than percentages had their figures converted.
2020 NATIONAL EMS ASSESSMENT – EMS PROFESSIONALS
May 27, 2020 Page 64
Criminal Background Checks
When and how are criminal background checks performed? - Self-declaration or local law enforcement endorsement only, for all purposes - Background check for initial licensing using state information only - Background check for initial licensing using state/federal information - Background check for relicensing using state information only - Background check for relicensing using state/federal information - No background check required
INITIAL LICENSING (n=54)
Figure 42
Figure 43
of states require a state and/or federal background check for initial
licensure.
2020 NATIONAL EMS ASSESSMENT – EMS PROFESSIONALS
May 27, 2020 Page 65
RELICENSURE (n=54)
Figure 44
Figure 45
of states require a state and/or federal background check for relicensure.
2020 NATIONAL EMS ASSESSMENT – EMS PROFESSIONALS
May 27, 2020 Page 66
C O M M E N T S
l DC: Background checks are the responsibility of the agency and the medical director has to aQest that there was no derogatory information or upload a copy of the check.
l DE: Mandatory self-report requirement after initial certification. l IA: Self declaration on initial certification and renewal positive responses are investigated by
the EMS bureau. No law enforcement endorsement required. l MA: Only when self-declared or background check when we have further info. l MD: CBIs are conducted upon initial and renewal of all certificates and licenses; receiving
allegations of alleged criminal activity. No fingerprints used; State & federal electronic Judiciary record search.
l ME: We do request state of residence background for the past 10 years for reciprocity applications.
l MS: We are working on legislative change to make this happen. l ND: This is in the process of becoming more stringent. l NY: When they apply for initial and recertification they need to identify if they have a criminal
record or pending actions. l OH: No state background checks required; self-declaration for initial and renewal certifications.
EMS training programs require background checks prior to clinical approval. l OK: Training programs will perform background checks for placement of students in clinical
seQings. l VA: All initial certifications self-declare. When joining and EMS agency a federal level
background check is required. l WV: Required by Legislative Rule.
2020 NATIONAL EMS ASSESSMENT – EMS COMMUNICATIONS
May 27, 2020 Page 67
EMS COMMUNICATIONS
Video Transmission (n=54)
What percentage of EMS agencies in your state use video to transmit patient, or other information, to health care providers for telehealth/telemedicine consultation?
Figure 46
2020 NATIONAL EMS ASSESSMENT – EMS COMMUNICATIONS
May 27, 2020 Page 68
Analysis
EMS agency use of video telemedicine/telehealth in real time is not common with 76% of respondents either reflecting no or unknown use of that modality. A dozen states (22%) reported up to ten percent of agencies employing video in this manner. The Northern Mariana Islands office reported 100% use with its single EMS agency. It will be interesting to see the impact on these numbers with the advent of the Centers for Medicare and Medicaid Innovation pilot project on Emergency Triage, Treatment, and Transportation, or “ET3”2 , which requires real time video telehealth for some purposes.
2 hTps://innovation.cms.gov/initiatives/et3/
Unknown24
44%
100%1
2%1-10%
1222%
None17
32%
Chart 43
2020 NATIONAL EMS ASSESSMENT – EMS COMMUNICATIONS
May 27, 2020 Page 69
Receive Electronic Patient Information (n=54)
How many EMS agencies in your state routinely receive electronic patient-specific medical history information from another healthcare entity? (e.g. hospital, health information exchange) for use during the patient’s EMS care {i.e., in real-time}) - None - Some - Less than half - Approximately half - More than half - All - Unknown
Figure 47
2020 NATIONAL EMS ASSESSMENT – EMS COMMUNICATIONS
May 27, 2020 Page 70
Analysis
The capability to receive critical patient history in real time at the scene has been considered advantageous from the advent of medical alert jewelry to patient information capsules at bedsides and in refrigerators. The ability to access patient health databases became a reality in 2004 when a health information exchange (HIE) system was linked to an Indianapolis EMS agency.3 The status, method and purpose of such connections was discussed in the 2017 Office of the National Coordinator of Health Information Technology publication cited above.
Fifteen years after the first instance of use, two-thirds of respondents indicated no or unknown use in their states. The variability in methods of introducing HIE capability includes systems aimed at hospitals, health systems, regions, and states with efforts based on home-grown software, hospital electronic health record products or EMS electronic patient care record systems. So, unless such initiatives are large or otherwise notable enough, it is understandable that they may be incomplete or below the radar.
Eighteen states (33%) report “some” or significant (half or all) agency levels of use.
3 Emergency Medical Services (EMS) Data Integration to Optimize Patient Care. Office of the National Coordinator for Health Information Technology. 2017.18. hTps://www.healthit.gov/sites/default/files/emr_safer_knowledge_product_final.pdf
Unknown22
41%
All1
2%
More Than Half1
2%
Some16
29% None14
26%
Chart 44
2020 NATIONAL EMS ASSESSMENT – EMS COMMUNICATIONS
May 27, 2020 Page 71
Send PCR to Another Entity (n=54)
How many EMS agencies in your state routinely send the electronic patient care report (ePCR) to another healthcare entity or provider (e.g. hospital, alternate destination) as a part of the EMS communication/notification in advance of the patient’s arrival (i.e., in real-time)? - None - Some - Less than half - Approximately half - More than half - All - Unknown
Figure 48
2020 NATIONAL EMS ASSESSMENT – EMS COMMUNICATIONS
May 27, 2020 Page 72
Analysis
Clinical condition and transport status reporting by EMS crews in the field to destination hospitals originated over fifty years ago with verbal radio reports from the scene or enroute to the hospital. Advances in software to digitally organize and transmit patient reports, and in communications systems to support them, hold the promise of more complete and earlier information available and easier to understand and use for hospital staff who will receive the patients. Thirty-nine percent of responding states said that “Some” to “Approximately Half” of all agencies have developed this capability.
Chart 45
Unknown18
33%
Approximately Half
36%
Less than Half
12%
Some17
31%
None15
28%
2020 NATIONAL EMS ASSESSMENT – EMS RESPONSE AND PATIENT CARE
May 27, 2020 Page 73
EMS RESPONSE AND PATIENT CARE
Agency Responses
In 2018, how many EMS agency responses were there in your state? - 911 response (scene) - 911 response (scene) – Pediatric only (ages 0-18) - Stand-by or other community/public safety support - Ground specialty care (e.g. interfacility, critical care, other transport) - Air medical services - Non-ambulance medical transports (e.g. wheelchair vans/ambuleLes) - Community paramedicine-type
All Response Type Totals by State
Table 45 State # of EMS
Responses (2018)
AK 46,957 AL 673,378 AR 449,479 AS No Response AZ 23,000 CA 6,318,081 CO 683,010 CT 750,000 DC 605,210 DE 285,788 FL 3,400,386 GA 1,970,931 GU 12,833 HI 144,803
State # of EMS Responses
(2018)
IA Unknown ID 209,502 IL 1,279,213 IN 772,213 KS 307,100 KY 863,968 LA Unknown MA 334,000 MD 1,086,501 ME 275,978 MI 1,259,030 MN 599,212 MO 750,000 MP 3,250
State # of EMS Responses
(2018)
MS 525,027 MT 105,121 NC Unknown ND Unknown NE 289,673 NH 258,706 NJ 1,750,000 NM 766,976 NV No Response NY No Response OH 1,637,490 OK 470,408 OR 500,000 PA 2,095,796
State # of EMS Responses
(2018)
PR No Response RI 180,000 SC 1,262,576 SD 74,163 TN 1,471,828 TX 3,600,000 UT 265,335 VA 1,564,080 VI 10,861 VT 86,598 WA 1,432,997 WI 725,535 WV 374,524 WY 81,816
2020 NATIONAL EMS ASSESSMENT – EMS RESPONSE AND PATIENT CARE
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Totals by Response Type
Table 46
RESPONSE TYPE # of
Responding States
Mean Median Min Max Total Responses
911 Response (scene) 41 693,691 357,991 3,000 6,306,907 28,441,321
911 Response (scene) – Pediatric Only
34 33,479 24,769 548 167,473 1,138,300
Stand-by or Other Community/ Public Safety Support
33 4,648 3,551 1 18,762 153,400
Ground Specialty Care Services 35 105,474 65,296 1 455,032 3,691,607
Air Medical Services 33 5,789 4,045 239 22,673 191,045
Non-Ambulance Medical Transport 6 7,278 2,512 1 26,369 43,670
Community Paramedicine-Type 9 1,625 1,522 28 5,528 14,627
Response Types Unknown 9 735,200 500,000 129,056 1,750,000 6,318,081
GRAND TOTAL 42,583,534
Analysis
There were over 42 million agency responses for EMS calls in 2018 in states that could document these numbers. Eight states however could not, including populous states such as New York and North Carolina. Over six million calls could not be aQributed to type of call. Seventy percent of the responses were 911 responses to the scene of an emergency, while 9% were for some form of interfacility or specialty care transport. There is some lack of consistency in how these numbers are calculated or estimated from agency to agency, event to event, and state to state. A call for a single patient injured may generate two or more “responses” if more than one agency is involved. Some responses are registered even if a patient is never encountered.
2020 NATIONAL EMS ASSESSMENT – EMS RESPONSE AND PATIENT CARE
May 27, 2020 Page 75
911 RESPONSE (SCENE) (n=41)
Table 47
RESPONSE TYPE # of
Responding States
Mean Median Min Max Total Responses
911 Response (scene) 41 693,691 357,991 3,000 6,306,907 28,441,321
C O M M E N T S
l CT: Based on incomplete year 2018 data
l IL: Includes mutual aid and intercepts
Figure 49
3
10 9
12
5
2
3,000-7,200
44,000-200,000
220,000-400,000
450,000-980,000
1.2 mil -1.6 mil
3.3 mil-6.3 mil
COUNTOF
STATES
# OF RECORDS
Chart 46
2020 NATIONAL EMS ASSESSMENT – EMS RESPONSE AND PATIENT CARE
May 27, 2020 Page 76
911 RESPONSE (SCENE) – PEDIATRIC ONLY (SPECIFIC AGE RANGE MAY VARY BY STATE) (n=34)
Table 48
RESPONSE TYPE # of
Responding States
Mean Median Min Max Total Responses
911 Response (scene) Pediatric Only 34 33,479 24,769 548 167,473 1,138,300
Chart 47
Figure 50
3
79
7 8
500-1,500
2,800-9,500
11,000-28,000
31,000-47,000
50,000-168,000
COUNTOF
STATES
# OF RECORDS
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STAND-BY OR OTHER COMMUNITY/PUBLIC SAFETY SUPPORT (n=33)
Table 49
RESPONSE TYPE # of
Responding States
Mean Median Min Max Total Responses
Stand-by or Other Community/ Public Safety Support
33 4,648 3,551 1 18,762 153,400
Chart 48
Figure 51
4
7
11
7
4
1-160 650-1,975
2,000-4,800
5,200-8,700
10,000-18,800
COUNTOF
STATES
# OF RECORDS
2020 NATIONAL EMS ASSESSMENT – EMS RESPONSE AND PATIENT CARE
May 27, 2020 Page 78
GROUND SPECIALTY CARE SERVICES (E.G., INTERFACILITY, CRITICAL CARE, OTHER TRANSPORT) (n=33)
Table 50
RESPONSE TYPE # of
Responding States
Mean Median Min Max Total Responses
Ground Specialty Care Services 33 111,685 61,868 100 455,032 3,685,606
Chart 49
Figure 52
5 56
76 6
1-200 1,700-6,000
11,000-46,000
50,000-100,000
115,000-220,000
250,000-460,000
COUNTOF
STATES
# OF RECORDS
2020 NATIONAL EMS ASSESSMENT – EMS RESPONSE AND PATIENT CARE
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AIR MEDICAL SERVICES (n=33)
Table 51
RESPONSE TYPE # of
Responding States
Mean Median Min Max Total Responses
Air Medical Services 33 5,789 4,045 239 22,673 191,045
Chart 50
Figure 53
68
68
4
225-2,000
2,025-3,900
4,000-5,800
6,000-9,800
10,000-23,000
COUNTOF
STATES
# OF RECORDS
2020 NATIONAL EMS ASSESSMENT – EMS RESPONSE AND PATIENT CARE
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NON-AMBULANCE MEDICAL TRANSPORT (E.G., WHEELCHAIR VANS/AMBULETTES) (n=6)
Table 52
RESPONSE TYPE # of
Responding States
Mean Median Min Max Total Responses
Non-Ambulance Medical Transport 6 7,278 2,512 1 26,369 43,670
Chart 51
Figure 54
2 2 2
1-75 1,450-3,575
12,200-26,400
COUNTOF
STATES
# OF RECORDS
2020 NATIONAL EMS ASSESSMENT – EMS RESPONSE AND PATIENT CARE
May 27, 2020 Page 81
COMMUNITY PARAMEDICINE-TYPE (n=9)
Table 53
RESPONSE TYPE # of
Responding States
Mean Median Min Max Total Responses
Community Paramedicine-Type
9 1,625 1,522 28 5,528 14,627
Chart 52
Figure 55
3
6
25 - 500 1,500 - 5,530COUNTOF
STATES
# OF RECORDS
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Patient Transpor ts
In 2018, how many estimated EMS patient transports were there in your state? - From scene to emergency department - From scene destination other than emergency department - Between facilities
Totals by State
Table 54
State Total # of
Patient Transports
AK 44,897 AL 394,349 AR 438,951 AS No Response AZ Unknown CA 4,201,000 CO 527,848 CT 316,162 DC 466,667 DE 285,549 FL 2,331,342 GA 1,488,248 GU 16,959 HI 88,937
State Total # of
Patient Transports
IA Unknown ID 139,020 IL 1,088,243 IN 588,389 KS 306,768 KY 1,137,605 LA Unknown MA 1,600,000 MD 812,800 ME 199,688 MI 1,338,132 MN 682,646 MO 750,000 MP 2,700
State Total # of
Patient Transports
MS 120,082 MT 95,961 NC Unknown ND Unknown NE 331,838 NH 162,575 NJ 2,250,000 NM 408,985 NV Unknown NY No Response OH 1,178,616 OK 530,380 OR Unknown PA 1,520,940
State Total # of
Patient Transports
PR No Response RI Unknown SC 1,014,846 SD 11,946 TN 1,180,270 TX Unknown UT 406,533 VA 1,082,830 VI 7,100 VT 70,695 WA 703,518 WI 521,786 WV Unknown WY 41,878
Totals by Scenario
Table 55
SCENARIO # of
Responding States
Mean Median Min Max Total
From Scene to ED 34 469,304 320,843 2,000 4,200,000 15,956,320
From Scene Destination to other than ED 19 85,619 40,124 9 532,226 1,626,763
Between Facilities 34 129,114 54,427 29 795,745 4,389,870 Transport Type Unknown 13 810,430 750,000 31,329 2,250,000 8,914,726
GRAND TOTAL 30,887,679
2020 NATIONAL EMS ASSESSMENT – EMS RESPONSE AND PATIENT CARE
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Analysis
The typical EMS call resulted in some 16 million transports documented from the scene of the call to the emergency department in 34 states in 2018. In 19 states, 1.6 million transports were made from a scene to a destination other an emergency department. This is unusual but will presumably become more commonplace as ambulance crews are encouraged through protocol and reimbursement practice changes to transport to more appropriate facilities. Nearly 9,000,000 records were of an unknown transport type. Twelve states observed limitations in their current data collection system as far as completeness is concerned.
2020 NATIONAL EMS ASSESSMENT – EMS RESPONSE AND PATIENT CARE
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FROM SCENE TO ED (n=34)
Table 56
SCENARIO # of
Responding States
Mean Median Min Max Total (%)
From Scene to ED 34 469,304 320,843 2,000 4,200,000 15,956,320
Chart 53
Figure 56
35
8 87
3
2,000-17,000
32,000-89,000
101,000-240,000
305,000-410,000
480,000-760,000
1,080,000-4,200,000
COUNTOF
STATES
# OF TRANSPORTS
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FROM SCENE DESTINATION TO OTHER THAN ED (n=19)
Table 57
SCENARIO # of
Responding States
Mean Median Min Max Total (%)
From Scene Destination to Other than ED 19 85,619 40,124 9 532,226 1,626,763
Chart 54
Figure 57
6
35
4
297-2,700
18,000-41,000
55,000-95,000
134,000-532,226
COUNTOF
STATES
# OF TRANSPORTS
2020 NATIONAL EMS ASSESSMENT – EMS RESPONSE AND PATIENT CARE
May 27, 2020 Page 86
BETWEEN FACILITIES (n=34)
Table 58
SCENARIO # of
Responding States
Mean Median Min Max Total
Between Facilities 34 129,114 54,427 29 795,745 4,389,870
Chart 55
Figure 58
46
97
6
2
25-900
7,600-20,000
29,000-66,000
75,000-120,000
190,000-440,000
720,000-800,000
COUNTOF
STATES
# OF TRANSPORTS
2020 NATIONAL EMS ASSESSMENT – EMS RESPONSE AND PATIENT CARE
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UNABLE TO DETERMINE TRANSPORT TYPE (n=13)
Table 59
SCENARIO # of
Responding States
Mean Median Min Max Total
Transport Type Unknown 13 810,430 750,000 31,329 2,250,000 8,914,726
Chart 56
Figure 59
1
32
5
31,300 120,000-235,000
750,000 1-2.2 million
COUNTOF
STATES
# OF TRANSPORTS
2020 NATIONAL EMS ASSESSMENT – EMS RESPONSE AND PATIENT CARE
May 27, 2020 Page 88
Patient Care Protocols (n=54)
How has your state implemented EMS patient care protocols?
Figure 60
Chart 57
79
3 4
12
16
3
Mandatory -Unchanged
Mandatory -Process toModify
Mandatory -Process toDevelop
Regional Local Model Other
COUNTOF
STATES
PATIENT CARE PROTOCOL IMPLEMENTATION
2020 NATIONAL EMS ASSESSMENT – EMS RESPONSE AND PATIENT CARE
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C O M M E N T S
l CO: Each local agency must have patient care protocols but agencies in some areas of the state have common medical direction and use county or regional protocols.
l IL: EMS Systems develop patient care protocols and submit to the state for approval. There are 11 EMS regions and some protocols are developed at the regional level and the systems in those regions sign off on them.
l ME: Mandatory statewide with the exception of our air medical service. l NJ: Statewide Mobile Intensive Care Clinical Protocols, with local variation and optional
medications. Non-mandatory BLS Clinical Protocols with local variation and optional medications.
l NV: Protocols must be developed based on the national standards per our regulations. l NY: Mandatory Statewide BLS protocols 75% of the state on collaborative ALS protocols, all
other regions create ALS protocols. All protocols created at regional level have to be approved by State EMS Council.
l OH: Have model statewide protocols for providers, however, each EMS service or agency develops its own protocols.
l WA: Each County MPD (Medical Program Director) have county protocols that must be followed by all agencies licensed and operating in that county under that MPD.
Analysis
The development of guidance by which EMS professionals practice has ranged from local medical director or hospital/agency-based to statewide, and from guidelines to mandatory practices. The first statewide mandatory protocols were established in Maine in 1992. Though a number of states have gone this direction, there remains discussion about balancing clear expectations and statewide practice consistency with flexibility in being able to respond to changes in medical practice standards for certain patient presentations. The NASEMSO Model EMS Clinical Practice Guidelines4 () have been created and are widely employed to support these efforts.
Nineteen states (34%) have mandatory protocols with varying ability to respond to requests to develop new/additional practices or to revise practices between editions of the protocols. Sixteen states (29%) make model guidelines available to shape local practice, while twelve states (21%) allow local protocols and four (7%) have regional protocols.
4 hTps://nasemso.org/wp-content/uploads/National-Model-EMS-Clinical-Guidelines-2017-PDF-Version-2.2.pdf
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Medication & Procedures Lists
Medications Permitted to Administer (n=54)
Does your state maintain a list of medications EMS professionals are permiLed to administer?
Figure 61
C O M M E N T
l IL: We have to approve all medications, so we don’t have an actual list, but we require what is allowed under the scope of practice. If additional meds are requested, we have to approve it
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Analysis
Seventy-seven percent of states maintain a list of permiQed medications and only one discerns between those permiQed specifically for advanced or basic life support professionals.
Procedures Permitted to Perform (n=54)
Does your state maintain a list of procedures EMS professionals are permiLed to perform?
Figure 62
No12
22%Yes, All Levels
4176%
Yes, ALS Only
12%
Chart 58
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C O M M E N T
l IL: We have to approve all procedures, so we don’t have an actual list, but we require what is allowed under the scope of practice. If additional equipment is requested, we have to approve it
Analysis
Eighty-three percent of states maintain a list of permiQed procedures and none discern between those permiQed specifically for advanced or basic life support professionals.
No9
17%
Yes, All Levels
4483%
Chart 59
2020 NATIONAL EMS ASSESSMENT – EMS RESPONSE AND PATIENT CARE
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of states require pediatric-specific safe transport devices (includes “car seat only”) to be carried on ambulances (n=21)
Figure 64
Pediatric Safe Transpor t Devices (n=54)
Does your state require pediatric-specific safe transport devices to be carried on ambulances? (if yes, please quote the requirement)
Figure 63
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C O M M E N T S
l AR: As listed in the Minimum Equipment sections of the Rules for Emergency Medical Services: Any pediatric restraint system.
l CO: 6 CCR 1015-3. 9.2.9 (Minimum Equipment Requirements, Safety Equipment): Child protective restraint system that accommodates a weight range between 5 and 99 pounds.
l CT: Pediatric passenger restraint system that either 1) is commercially manufactured for the specific purpose of securing a pediatric patient within the patient compartment of an ambulance during transport or 2) a child passenger restraint system that meets the requirements of the Code of Federal Regulations, Title 49, Part 571.213, as amended, child restraint systems, and displays a permanent label indicating all information required by such regulations, including but not limited to the following: ‘‘This child restraint system conforms to all applicable Federal Motor Vehicle Safety Standards.’’ This requirement is listed on page 6 of the Statewide Minimum Equipment List. Basic ambulances are strongly encouraged to carry a child passenger restraint system(s) that meets the requirements of the Code of Federal Regulations, Title 49, Part 571.213, as amended, child restraint systems, and is able to accommodate both infants and children up to a weight of at least 60 pounds. Ambulances may only transport children who are not patients but weigh less than 60 pounds and or are less than 6 years of age if the child is restrained in a compliant child restraint system. This is listed on page 7 of the Statewide Minimum Equipment List.
l GA: From our Vehicle Inspection Form: Equipment for the safe transport of pediatric patients, as approved by the local EMS medical director with guidelines provided by the department.
l KY: 202 KAR 7:550, Sec. 2: A pediatric transport device with a minimum weight range of ten (10) to forty (40) pounds.
l MA: Statute requires that all children under the age of 8 traveling in a motor vehicle must be secured in a child passenger restraint (aka car seat), unless they are 57 inches or taller, in which case, they need to be using a seat belt. An ill or injured child must be restrained in a manner that minimizes injury in an ambulance crash. The best location for transporting a pediatric patient is on the ambulance cot. The method of restraint will be determined by various circumstances including the child’s medical condition and weight. More information can be found in our Statewide Treatment Protocols (Protocol 1.0: Ambulance Stretcher Operations & Protocol 7.4: Pediatric Transport).
l MD: Requirement for Commercial Ambulances (ALS {line 136}, BLS {line 136}, Neonatal {line 1} Equipment Checklists): Size-appropriate child restraint system compliant with Federal specification FMVSS-213 injury criteria. Voluntary for Public Safety 911 Ambulances as listed in the Voluntary Ambulance Inspection Program – Seal of Excellence (line 136).
l MI: An entire protocol has been developed on safe transport of children based on NHTSA recommendations. Protocols in this state have the same force and effect as law.
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l NC: 10A NCAC 13P .0207 (a)(3)(B) (Ground Ambulance: Vehicle and Equipment Requirements): the availability of one pediatric restraint device to safely transport pediatric patients and children under 40 pounds in the patient compartment of the ambulance.
l NH: As indicated in State of New Hampshire Patient Care Protocols Version 7.1 (8.13 Pediatric Transportation): NH RSA 265:107-a requires all children up to 57 inches to be properly restrained in a safety seat or harness when riding in a vehicle. Any child who fits on a length-based resuscitation tape is 57 inches or less in height. An ill or injured child must be restrained in a manner that minimizes injury in an ambulance crash. The best location for transporting a pediatric patient is secured directly to the ambulance cot. Never allow anyone to hold an infant or child on the stretcher for transport.
l NJ: We do require a child passenger restraint; however it isn’t specific to what type. Statute requires that all children under eight years of age weighing 80 pounds or less shall be properly restrained in a federally-approved child restraint system as provided for at N.J.S.A. 39:3- 76.2a, or, if such a child passenger is a patient and it is medically appropriate, and subject to N.J.A.C. 8:40-6.8(d) in a wheelchair or on a stretcher.
l OK: OAC 310:641-3-23 Equipment for ground ambulance vehicles. As approved by local medical direction, a child restraint system or equipment for transporting pediatric patients.
l OR: Oregon Administrative Rule 333-255-0072(2)(r): requires ground ambulances to carry “Appropriately-sized child restraint system(s) that, at a minimum, covers a weight range of between 10 and 99 pounds.”
l PA: EMS Information Bulletin 2017-21: Allowance of Multiple Pediatric Safe Transport Devices: The device or devices (if multiple-must collectively meet) must meet the weight requirements identified of 10 to 99 pounds ( 4.5 - 45kg). EMS Information Bulletin 2017-11: Pediatric Safe Transport Devices: a "pediatric safe transport device" can be interpreted to mean a product, designed to fit a child, that properly secures them into the ambulance patient care compartment. This device could be for use on an ambulance liQer with at least two aQachment points to the liQer and incorporating a multi-point restraint system, or as a built-in product in the patient care compartment seat, and that the device have a minimum weight range of between 10 and 99 pounds (4.5 - 45kg).
l RI: Required per state protocol (Rhode Island Statewide Emergency Medical Services Protocols, Routine Patient Care #22): Pediatric patients of appropriate age, height or weight shall be transported utilizing a restraint system (child safety seat) compliant with Federal Motor Vehicle Safety Standards (FMVSS). The car safety seat shall be properly affixed to a stretcher with the head section elevated or to a vehicle seat, unless the patient requires immobilization of the spinal column, pelvis, or lower extremities; or the patient requires resuscitation or management of a critical problem.
2020 NATIONAL EMS ASSESSMENT – EMS RESPONSE AND PATIENT CARE
May 27, 2020 Page 96
l VT: Listed on the Ambulance Vehicle Inspection & License form. During our inspections we go through the pediatric restraint devices in each ambulance and include the type and expiration. Although we do not have a weight requirement, our Pediatric Safe Program requires devices that cover up to 99 pounds.
l WV: Ground Ambulance Equipment and Supply List (H. Safety): Pedi-Mate® child occupant protection system. Additionally, agencies do in-service training on how to use the Pedi-Mate and many WV educational institutes include this in their initial EMT course.
Analysis
Thirty-nine percent of states require some type of pediatric safe transport devices to be carried on ambulances (to include two states who require only a car seat). Over 1.5 million transports of pediatric patients in ambulances occur every year.5 While there are several devices on the market utilized for these purposes, crash test standards do not exist making evaluation of device safety impossible.
5 National Emergency Medical Services Information System, Version 2 Data Cube. hTps://nemsis.org/view-reports/public-reports/ems-data-cube/. Accessed April 1, 2019.
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May 27, 2020 Page 97
EMS INFORMATION SYSTEMS
Submission Requirements
How does the state acquire EMS response and patient care data from the following agency types? - Submission required through regulation/law (includes effective enforcement provisions) - Submission required through regulation/law (with no effective enforcement provisions) - Submission not required through regulation/law, but highly encouraged/ enabled to submit - No requirements, but plan to require submission in the next few years - No plans to require submission in the near future
Chart 60
25
3
3
4
0
14
2
1
2
2
9
4
6
9
4
6
12
12
8
11
0
33
32
31
37
EMD(n=54)
Air medical(n=54)
Ground specialty care(n=54)
911 w/o transport(n=54)
911 w/transport(n=54)
EMD(n=54)
Air medical(n=54)
Ground specialtycare(n=54)
911 w/otransport(n=54)
911 w/transport(n=54)
Required(w/enforcement) 0 33 32 31 37
Required(no enforcement) 6 12 12 8 11
Not required(encouragedto submit)
9 4 6 9 4
Not required(have future plans) 14 2 1 2 2
Not Required(no future plans) 25 3 3 4 0
2020 NATIONAL EMS ASSESSMENT – EMS INFORMATION SYSTEMS
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Analysis
Forty-eight states (89%) require 911 ground ambulance services to submit EMS response and patient care data, and no state is without plans to encourage them to submit if they are not already doing so. Forty-five states (83%) require air medical services to submit and 44 states (81%) require ground specialty services to do so. Thirty-nine states (72%) require non-transporting 911 response agencies to submit data. The lesser emphasis on this last type of response agency may result from a lack of state EMS office authority to collect this data from non-ambulance agencies or certain types of EMS organizations, or a desire to avoid data duplication when non-transporting and transporting agencies respond to the same incidents.
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911 RESPONSE (SCENE) WITH TRANSPORT (n=54)
Figure 65
Chart 61
37
11
42
Required(w/enforcement)
Required(no enforcement)
Not Required(encouraged to
submit)
Not Required(have future plans)
COUNTOF
STATES
DATA SUBMISSION REQUIREMENT
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C O M M E N T S
l Required (w/enforcement) ¡ NJ: For licensed programs. Non-licensed program compliance may be affected through
licensed clinician requirements. l Required (no enforcement)
¡ NE: Enforcement would be if they are in violation of regulations and could have disciplinary action taken.
l Not Required (encouraged to submit) ¡ AZ: A couple of agencies are required to submit data as an agreement/requirement of
special circumstances. ¡ WA: On the EMS agency renewal application for licensure, we collect the numbers of
responses and transports for the previous 12 months.
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911 RESPONSE (SCENE) WITHOUT TRANSPORT (n=54)
Figure 66
Chart 62
31
8 9
24
Required(w/enforcement)
Required(no enforcement)
Not Required(encouraged to
submit)
Not Required(have future plans)
Not Required(no future plans)
COUNTOF
STATES
DATA SUBMISSION REQUIREMENT
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C O M M E N T S
l Required (w/enforcement) ¡ PA: Non-transport EMR exempted ¡ NE: Enforcement would be if they are in violation of regulations and could have
disciplinary action taken l Required (no enforcement)
¡ DC: Building out submission capability now l Not Required (encouraged to submit)
¡ KS: Submission is required for permiQed ambulance services, but not for agencies that solely provide response, but no transport
¡ WA: On the EMS agency renewal application for licensure, we collect the numbers of responses and transports for the previous 12 months
l Not Required (no future plans) ¡ IL: Required for ambulances only; for non-transporting vehicles such as engines or trucks,
submission is not required
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GROUND SPECIALTY CARE SERVICES (E.G., INTERFACILITY, CRITICAL CARE, OTHER TRANSPORT) (n=54)
Figure 67
Chart 63
32
12
6
13
Required(w/enforcement)
Required(no enforcement)
Not Required(encouraged to
submit)
Not Required(have future plans)
Not Required(no future plans)
COUNTOF
STATES
DATA SUBMISSION REQUIREMENT
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C O M M E N T S
l Required (no enforcement) ¡ NE: Interfacility transport only; Critical Care is not recognized.
l Not Required (encouraged to submit) ¡ WA: On the EMS agency renewal application for licensure, we collect the numbers of
responses and transports for the previous 12 months.
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AIR MEDICAL SERVICES (n=54)
Figure 68
Chart 64
33
12
42 3
Required(w/enforcement)
Required(no enforcement)
Not Required(encouraged to
submit)
Not Required(have future plans)
Not Required(no future plans)
COUNTOF
STATES
DATA SUBMISSION REQUIREMENT
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C O M M E N T S
l Required (w/enforcement) ¡ AZ: Each air ambulance services is required to submit to the Office of EMS a monthly run
log of the previous month's missions l Required (no enforcement)
¡ DC: Building out submission capability now ¡ NE: Air services are treated the same and licensed the same as an ALS Service.
l Not Required (encouraged to submit) ¡ WA: On the EMS agency renewal application for licensure, we collect the numbers of
responses and transports for the previous 12 months
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EMERGENCY MEDICAL DISPATCH (EMD) CENTER (n=54)
Figure 69
Chart 65
69
14
25
Required(no enforcement)
Not Required(encouraged to
submit)
Not Required(have future plans)
Not Required(no future plans)
COUNTOF
STATES
DATA SUBMISSION REQUIREMENT
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NEMSIS
Versions Collecting
Which versions of NEMSIS is your state collecting?
Chart 66
Analysis
Forty-two states (78%) collect/accept NEMSIS Version 3.4 data. The numbers for states accepting other versions include many accepting 3.4 because they are accepting more than one version. This has raised some concern about how data are aggregated when using NEMSIS versions with different standards/definitions. Of the seven states who indicated they collect an “other” version, none indicated what that other version is. The data received on percentage of records collected annually for each version was negligible.
20
8
27
32
7
42
21
17
Other Version(n=27)
Version 3.4(n=50)
Version 3.3.4(n=48)
Version 2(n=49)
Other Version(n=27)
Version 3.4(n=50)
Version 3.3.4(n=48)
Version 2(n=49)
Yes, collect/accept 7 42 21 17No, do not collect/accept 20 8 27 32
Yes, collect/accept No, do not collect/accept
2020 NATIONAL EMS ASSESSMENT – EMS INFORMATION SYSTEMS
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VERSION 2 (n=49)
Figure 70
Figure 71
35% of states collect NEMSIS Version 2 data (n=17)
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NEMSIS VERSION 3.3.4 (n=49)
Figure 72
Figure 73
45%
of states collect NEMSIS Version 3.3.4 data (n=22)
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NEMSIS VERSION 3.4 (n=49)
Figure 74
Figure 75
84% of states collect NEMSIS Version 3.4 data (n=41)
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Transition to v3.4.0 (n=54)
When does your state plan to be completely transitioned to v3.4.0?
Figure 76
Chart 67
37
71 2
7
Complete December2020
December2021
December2022
Unknown
COUNTOF
STATES
NEMSIS V3.4.0 TRANSITION
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C O M M E N T S
l Unknown ¡ CT: Our deadline for beginning to submit records in v3.4.0 was June 30, 2017. We may need
to accept and convert additional records from 2019, 2018 and 2017, however some fields will not be converted, for example ICD9 to ICD10, and some fields may not have an exact translation. Our vendor will convert remaining v2.2.1 records if submiQed, so we will be contacting EMS agencies and their software vendors. However, this does not mean translation of ICD9 to ICD10.
¡ LA: Not collected by the Bureau of EMS ¡ MN: Board Decision, hoping for December 2020 ¡ OK: Continuing discussion ¡ TX: Working with NEMSIS to complete a transition plan ¡ WV: There have been issues with vendors and state data program being compatible
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Percentage of Responses Submitted to State Database (n=54)
What approximate percentage of your total 2018 agency response records were submiLed to your state’s ePCR database?
Figure 77
Chart 68
10
2
1
2
4
22
13
Unknown
0%
1-25%
26-50%
51-75%
76-99%
100%
COUNT OF STATES
% OF
2018
RECORDSIN
STATE
DATABASE
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Analysis
Thirteen states (24%) reported that all 2018 agency response records made it to their state ePCR database. In comparing these states with their responses on an earlier question on whether data submission is required and enforced, there is correlation of this result with states requiring and enforcing data submission. The exceptions were a smaller state which requires, but does not enforce, submission having 100% submission, and two island territories which do not require submission but have a single agency with which to deal.
An additional 22 states (41%) achieve receipt of 76% to 99% of their responses in their databases. These also are generally states requiring submission, with or without enforcement.
Some states requiring submission had unknown percentages of response records in their databases. Three out of four mainland states not requiring submission had unknown percentages of submission.
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Percentage of Responses Sent to NEMSIS (n=54)
What approximate percentage of your state’s 2018 calls were/will be sent to NEMSIS?
Figure 78
Chart 69
9
5
1
1
3
16
19
Unknown
0%
1-25%
26-50%
51-75%
76-99%
100%
COUNT OF STATES
% OF
2018
RECORDSSENTTO
NEM
SIS
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Analysis
Nineteen states (35%) sent, or will send, 100% of their 2018 calls to NEMSIS. Another 16 states (30%) would or will provide 76% to 99% of their calls. While this is the same number of states (35) that in the previous question reported that 76% to 100% of 2018 agency response records made it to their state ePCR databases, there is not a complete correlation of states saying both.
Twelve states said that they collected all of their 2018 response records but 18 said that all of their calls were or will be sent to NEMSIS. Perhaps some states reporting “not collecting all 2018 response records” believed they eventually would, and would submit them to NEMSIS, or that they collected less than all response records but sent all that they had to NEMSIS. At least two states that reported collecting 100% of their agency response records also reported that they had or would deliver less than 100% to NEMSIS.
These observations may be aQributed to the potential created for different interpretations of these questions, but they do raise points for further examination.
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Submission Frequency (n=54)
How frequently after the EMS event are agencies required to submit data to the state?
Figure 79
Chart 70
7
10
04
7
1
5
20
No Requirement
Other
1 year
Quarterly
30 days
7 days
72 hrs
24 hrs
COUNT OF STATES
SUBMISSION
REQUIREMENT
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C O M M E N T S
l Within 24 hours ¡ RI: 2 hours after the call
l Other ¡ CO: Within 60 days ¡ IA: 90 days after each quarter ¡ IL: By the 15th of each month ¡ KY: Fifteenth day of the month following the incident ¡ MI: By the 15th of the month for the previous month ¡ MS: 14 days or as required by SHO for syndromic surveillance ¡ MT: 60 days after the end of quarter ¡ OH: 15 days after the month in which the incident occurred ¡ OK: The last business day of the following month ¡ VI: The State is the primary EMS Response Agency
Analysis
Rhode Island (at two hours by their comment) and 19 other states (37%) require submission of data within 24 hours of the event. Another eight, plus six from comments for those responding “Other”, (26%) are required to submit within an approximate monthly window. Submission generally within the quarter following the incident, including three from comments for those responding “Other”, is required by seven states (13%). Seven states (13%) have no requirement.
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Data Linkage/Sharing (n=52)
Which of the following healthcare-related data systems are operationally linked to/with your EMS data system? - Motor vehicle crash system - Traffic records system - Health information exchange - Emergency department - Hospital discharge database - Trauma registry - Stroke registry - STEMI registry - Medical examiners - Vital statistics (death certificates) - Other
Chart 75 and Figure 74 identify the number of different healthcare-related data systems to which states operationally link and are inclusive of CARES (state only) and Biospatial participation.
Chart 71
6
32
12
2 1
None 1-3 Linkages 4-6 Linkages 8 Linkages 11
COUNTOF
STATES
# OF DIFFERENT SYSTEM LINKAGES
2020 NATIONAL EMS ASSESSMENT – EMS INFORMATION SYSTEMS
May 27, 2020 Page 121
Figure 80
Analysis
Linkages of the sort reported here are generally an exception rather than a rule. The frequency of each of the linkages displayed below in states is four to eighteen percent in most cases. Hawaii, Utah, and Virginia have eight to eleven linkages, four states have “four to six” linkages (8%), and 31 states (60%) have “one to three” linkages. The exceptions include long-standing efforts such as trauma registry linkages (begun three decades ago) which exist in about half the states, and other “systems of care” linkages (STEMI and stroke at 13% and 19% respectively, and for which there is a paQern of linkage in several states). Another exception, described in the maps below, is participation in the Biospatial and Cardiac Arrest Registry to Enhance Survival (CARES) programs. These became evident from comments received in the survey.
C O M M E N T
l AZ: "Operationally linked" means we manually link the data systems via SAS
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MOTOR VEHICLE CRASH SYSTEM (n=52)
Figure 81
TRAFFIC RECORDS SYSTEM (n=52)
Figure 82
No46
88%
Yes6
12%
No48
92%
Yes4
8%
Chart 72
Chart 73
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May 27, 2020 Page 123
HEALTH INFORMATION EXCHANGE (n=52)
Figure 83
EMERGENCY DEPARTMENT (n=52)
Figure 84
No43
83%
Yes9
17%
No46
88%
Yes6
12%
Chart 75
Chart 74
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May 27, 2020 Page 124
HOSPITAL DISCHARGE DATABASE (n=52)
Figure 85
TRAUMA REGISTRY (n=52)
Figure 86
No48
92%
Yes4
8%
No26
50%
Yes26
50%
Chart 76
Chart 77
2020 NATIONAL EMS ASSESSMENT – EMS INFORMATION SYSTEMS
May 27, 2020 Page 125
STROKE REGISTRY (n=52)
Figure 87
STEMI REGISTRY (n=52)
Figure 88
No42
81%
Yes10
19%
No45
87%
Yes7
13%
Chart 78
Chart 79
2020 NATIONAL EMS ASSESSMENT – EMS INFORMATION SYSTEMS
May 27, 2020 Page 126
MEDICAL EXAMINERS (n=52)
Figure 89
VITAL STATISTICS (DEATH CERTIFICATES) (n=52)
Figure 90
No48
92%Yes4
8%
No50
96%
Yes2
4%
Chart 80
Chart 81
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OTHER DATA SYSTEMS LINKAGES – COMMENTS (n=7)
l CT: We are doing linking studies with Yale and UCONN (opioids and MVAs), but as yet have no routine operational link between our system and others. In addition, we want to be able to link EMS records to trauma registry records.
l LA: Burn l MD: OD MAP l MS: NREMT for licensure; NCBP l NV: During our migration to our new system, data from call reports related healthcare
specialties is collected by the specialty department/agency from the main system through their access to the data.
l TX: CRASH--TX DOT l WY: 2 hospitals receive EMS data
BIOSPATIAL PARTICIPATING STATES
(data from Biospatial)
Figure 91
2020 NATIONAL EMS ASSESSMENT – EMS INFORMATION SYSTEMS
May 27, 2020 Page 128
CARES PARTICIPATING STATES
(data from MyCares.net, as of February 26, 2020: https://mycares.net/sitepages/uploads/2019/CARES%20Map%20(Sept%202019).png)
Figure 92
2020 NATIONAL EMS ASSESSMENT – EMS INFORMATION SYSTEMS
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Additional comments as they relate to linking data with other systems:
l AK: Working with State Trauma Registry and State Motor Vehicle Crash systems to incorporate reporting into Biospatial
l AZ: HIE linkage with the State EMS Registry is expected later this year; The University of Arizona links the EMS Registry to the Cardiac Arrest Registry and TBI Registry
l CO: We are in the process of linking to a health information exchange l FL: Plans to link with Trauma Registry and Health information exchange by December 2020 l GA: We link to the trauma registry, stroke registry, discharge data, emergency department data
outside of the automatic linkage l GU: Plans to develop links in process with stakeholders l KS: We are in the early stages of using the Biospatial platform to link with crash reports,
trauma, prescription drug monitoring, and ER discharge data l KY: Legal process is a continuing hurdle to the operational linkage of data l MA: Some HIE linkages l MI: We are working with other state entities and Biospatial on the potential to link EMS records
with the MVC records and the trauma registry; Very interested in working with other partners in the future such as vital statistics and Stroke/STEMI Registry
l MS: Anticipate Trauma by spring 2020 l NE: We do not have operational links to the data but we do have linkages on a data mart that
connects to other systems l NV: During our migration to our new system, data from call reports related healthcare
specialties is collected by the specialty department/agency from the main system through their access to the data
l OH: Ohio is currently working on a project that will permit linkage between EMS and Trauma data; estimate completion in late 2020
l OK: We can link databases, and we can through Memorandums of Agreements and Data Use Agreements provide data to other databases and organizations
l SC: Will have trauma and stroke within 14 months l UT: We anticipate motor crash vehicle data linked by end of 2019 l WY: We are in the process of establishing connection with HIE
2020 NATIONAL EMS ASSESSMENT – EMS INFORMATION SYSTEMS
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PROVIDE DATA (n=54)
To which of the following does your state routinely make available or supply EMS data? (select all that apply) - State department of transportation - State department of highway safety - State law enforcement agency - State or local health information exchange - Regulatory agency for hospitals - Other
Figure 93
Chart 82
1117 18
8
None 1 2-3 4-5
# OF
STATES
# OF ENTITY LINKAGES
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Analysis
Forty-three states (80%) supply EMS data to one or more other data users. Twenty-six (48%) supply data to two or more. State highway safety departments receive data from 24 states (46%), the most prevalent recipients.
STATE DEPARTMENT OF TRANSPORTATION (n=54)
Figure 94
No37
69%
Yes17
31%
Chart 83
2020 NATIONAL EMS ASSESSMENT – EMS INFORMATION SYSTEMS
May 27, 2020 Page 132
STATE DEPARTMENT OF HIGHWAY SAFETY (n=54)
Figure 95
STATE LAW ENFORCEMENT AGENCY (n=54)
Figure 96
No30
56%
Yes24
44%
Chart 84
No40
74%
Yes14
26%
Chart 85
2020 NATIONAL EMS ASSESSMENT – EMS INFORMATION SYSTEMS
May 27, 2020 Page 133
STATE OR LOCAL HEALTH INFORMATION EXCHANGE (n=54)
Figure 97
REGULATORY AGENCY FOR HOSPITALS (n=54)
Figure 98
No45
83%
Yes9
17%
Chart 86
No47
87%
Yes7
13%
Chart 87
2020 NATIONAL EMS ASSESSMENT – EMS INFORMATION SYSTEMS
May 27, 2020 Page 134
OTHER (n=54)
Figure 99
C O M M E N T S ( O T H E R )
l AK: CDC
l AL: Varied agencies as requested; Alabama Dept. of Public Health
l AZ: Hospitals (case-by-case basis) and some county health departments (limited specific data)
l CO: We supply aggregate reports to various entities upon request
l FL: Department of Children and Families
l GA: Open records requests and Public Health Information Portal requests
l GU: Via Lifequest and ImageTrend Software and Guam Memorial Hospital
l ID: Licensure information for Department of Labor
l IL: Request by local EMS provider or EMS System
l KS: Provide to hospitals
l KY: Public Health, HIDTA, Injury Prevention and Research Center
l ME: Maine CDC
l MI: Bureau of Epidemiology, Local Health Departments as requested (Opioid OD data)
l MO: Others aggregate by request
No31
57%
Yes23
43%
Chart 88
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May 27, 2020 Page 135
l MS: Trauma, STEMI, Stroke, CARES, Epidemiology, Homeland Security, Fusion Center, University of Mississippi Medical Center
l NH: Opioid data to various state agencies
l NJ: County and local health departments
l OH: Ohio Department of Health
l OK: Medical Examiner’s Office, Injury Prevention Office at OSDH
l PA: Routinely provide information related to EMS naloxone utilization to our opioid command center
l UT: Researchers
l VT: State Epidemiology, State Alcohol and Drug Prevention
l WY: Based on request
Additional comments as they relate to providing data to other agencies/ organizations:
l CT: We cannot link data that we have not received, so we are working on data submission and system acceptance of data, which have been ongoing problems.
l MI: Biospatial has been extremely helpful and we are working on case definitions of public health requested data such as the opioid OD data. Our state has an extremely lengthy and thorough process for data sharing. The ImageTrend report writer is very cumbersome, so most reports are being generated and will be provided utilizing the Biospatial platform.
l NV: We continue to involve other specialties that can benefit from data collected to aid in beQer patient outcome and recovery through treatment, environmental, social, etc., changes.
l OH: Aggregated data sets are made available to external requestors on a case by case basis.
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Public Health Surveillance
PROVIDE DATA/ANALYTICS TO MONITOR PUBLIC HEALTH OUTBREAKS/TERRORISM (n=54)
Does your state EMS patient care reporting data system provide data and/or analytics in order to participate in a public health surveillance system used to monitor for public health outbreaks or acts of terrorism?
Figure 100
Figure 101
61%
of states provide data/analytics to monitor public health outbreaks or terrorism (n=33)
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SOURCES USED TO PARTICIPATE IN PUBLIC HEALTH SURVEILLANCE (n=33)
Which of the following sources are used to participate in public health surveillance?
Chart 89
C O M M E N T S ( O T H E R )
l AZ: Raw data l HI: Hawaii Poison Center l IN: Management Performance Hub - Naloxone administration heatmap l NH: Internal monitoring by DHHS surveillance specialists
EPCR DASHBOARD VENDOR (n=14)
If you indicated that you use an ePCR system dashboard, which vendor do you use? (n=14)
Chart 90
C O M M E N T S ( O T H E R )
l AL: Center for Advancement in Public Safety, University of Alabama
l DC: Digital Innovations l IL: EMS System Data Inc l ND: ESO Solutions l PA: Cloud PCR
16 15 15 14 13
6 64
Biospatial NEMSISDashboards
CARES ePCRDashboard
Homegrown ODMAP GWTG Other
COUNTOF
STATES
PUBLIC HEALTH SURVEILLANCE SOURCES
9
5
ImageTrend Other
COUNTOF
STATES
VENDOR
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Benchmarking
Does your state’s data system provide benchmarking capabilities between:
Chart 91
Analysis
Benchmarking is the ability to provide statistical comparisons of performance. Fourteen states (26% of the 54 survey respondents) were able to compare themselves other states. Systems in 23 states (43%) allow for county to county comparisons within their state, and 26 (48%) enable agency to agency comparisons.
0
27
29
36
4
26
23
14
Other(n=4)
EMS Agencies(n=53)
Counties(n=52)
States(n=50)
COUNT OF STATES
Yes No
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EMS Compass
PERFORMANCE MEASUREMENT INDICATORS (n=52)
Does the state’s EMS data system include EMS Compass-based performance measurement indicators?
Figure 102
Analysis
EMS Compass was a NASEMSO/NHTSA project to scientifically establish EMS agency performance measures to enable improved benchmarking. It originally established 14 such measures. The effort is now being continued by the National EMS Quality Alliance (NEMSQA).
58%
of state’s EMS data systems include EMS Compass-based performance measure indicators (n=30)
Figure 103
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MEASURE STATE-LEVEL SYSTEM PERFORMANCE (n=52)
Does the state EMS office use EMS Compass indicators in measuring state-level system performance?
Figure 104
37%
of states use EMS Compass indicators in measuring state-level system performance (n=19)
Figure 105
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ADDITIONAL COMMENTS
Additional comments as they relate to providing data to public health surveillance/dashboards:
l AZ: We don't use them as the data quality or collection of some of the elements is low. l GA: The EMS Compass measures, while we use them some, are very basic, and I think we need
more robust and beQer-defined national EMS measures. l ID: We have only transitioned approximately 1% to NEMSIS v3 and do not expect to fully
transition until 12/20. l MA: EMS Compass was not supported as a performance model and have not seen any changes
in regards to that. The initial idea for EMS Compass was excellent. l MI: We did not use them in 2018 as we were in the process of transitioning to NEMSIS v. 3.4.
We plan to begin utilizing some of the EMS Compass measure benchmarking reports in 2019. l MT: We are currently working towards utilization of EMS Compass measures. l NH: Our system can run Compass-related measures, we only occasionally look at them. l NY: We use standards created in collaboration with the state ems medical directors council. l OR: Plan to use COMPASS for dashboards and benchmarking. l PA: System does not currently have as an automated function, all analysis done manually. l WY: Benchmark development is currently in progress.
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EMS WORKFORCE HEALTH AND SAFETY
Health/Wellness Programs (n=54)
Does your state recommend any particular health/wellness programs for EMS professionals?
Figure 106
Figure 107
19%
of states recommend health/ wellness programs for EMS professionals (n=10)
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C O M M E N T S
l Yes ¡ MT: Mental Health First Aid for Fire/EMS ¡ NH: We have been providing extensive training on provider mental health. ¡ NJ: We are instituting statewide promotion of the ImageTrend Crew Care application this
year. ¡ TX: PuQing in place an EMS Referral Program for drugs and mental health issues for the
statewide EMS work force l No
¡ AZ: The Bureau of EMS & Trauma System has a draft curriculum that will be made available for online training for EMCTs.
¡ FL: Increasing the number of EMS agencies offering health and wellness program is a Goal within the EMS State Plan.
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Access to CISM Resources (n=54)
Do all EMS agencies have access to a critical incident stress management (CISM) resource?
Figure 108
Chart 92
37
610
1
Yes - All Yes - Some No Unknown
COUNTOF
STATES
ACCESS TO CISM RESOURCE
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C O M M E N T S
l Yes – All ¡ CO: There are numerous organized volunteer CISD teams throughout the state that can
serve all areas and types of first response agencies upon request. ¡ MI: There are CISM Teams available in all regions of the state and legislation acknowledges
CISM. However it is unknown how many or how often agencies tap into this response. ¡ MT: CISM teams are available through county level DES. ¡ ND: Probably could have more options. ¡ NE: State has a Critical Incident Stress Management that considers all information discussed
as confidential and cannot be used in court. ¡ SC: SC FAST Team 24/7/365 all regions, all counties.
l Yes – Some ¡ AZ: The majority of Arizona EMS agencies have a resource in place. ¡ CA: Many EMS agencies have CISM programs but not all. ¡ IL: Most do but not sure if they all do. ¡ MA: We have many resources. Not sure they are all in place but we have seen their use and
it is wriQen into SOPs. ¡ OH: Generally yes, not tracked by the state. ¡ WI: No formal requirement. Professional Fire Fighters of Wisconsin have significant
resources that they have been willing to share in the past. l Unknown
¡ AL: Neither provided nor regulated by OEMS.
Analysis
It is not surprising that the responses to the health and wellness programming and the critical incident stress management (CISM) resource questions above demonstrate an almost opposite result. The former reflects 44 states (81%) not recommending any particular resources while 80% report “All” (37 states) or “Some” (6 states) agencies having access to CISM resources.
Health and wellness programming tends to derive from specific issues addressed by governmental occupational health and safety agencies, the EMS literature, consulting products, and other sources focused on local EMS agency management. Myriad products such as model agency standard operating procedure templates, articles, manuals, and training programs result. While the comments reflect some statewide efforts to develop resources and encourage local program development, this does not seem to generally include ferreting out and selecting specific programs or products in which to invest in disseminating. These resource offerings and the needs of services in this regard may be too complex for such a standardized approach to recommending resources.
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Critical incident stress debriefing/management (CISD/M) dates back decades and focused on the development of teams and other resources for, initially, emergency intervention and, later, ongoing programming. In early years, these programs were established on a regional or statewide basis as the needs and resources for interventional support (CISD) did not fit single agencies. The more extensive history of a common approach to intervention and long-term management and the regional/state program adoption to developing resources and supporting their evolution from CISD to CISM seems to have cemented the availability of these resources.
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Workforce Monitoring
Does your state monitor (in any formal way)? - on the job EMS injuries - on the job EMS blood borne pathogen exposures - on the job EMS deaths - EMS vehicle crashes
ON THE JOB EMS INJURIES (n=52)
Figure 109
Figure 110
21% of states monitor on the job EMS injures (n=11)
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ON THE JOB EMS BLOOD BORNE PATHOGEN EXPOSURES (n=52)
Figure 111
Figure 112
23%
of states monitor on the job blood borne pathogen exposures (n=12)
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ON THE JOB EMS DEATHS (n=53)
Figure 113
Figure 114
36% of states monitor on the job EMS deaths (n=19)
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EMS VEHICLE CRASHES (n=52)
Figure 115
Figure 116
55% of states monitor EMS vehicle crashes (n=29)
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Analysis
The monitoring of on the job injuries and bloodborne pathogens exposures was indicated by a nearly equal percentage of states (21-23%) while 79-77% said they did not monitor. Nineteen states (36%) monitor EMS job deaths, the remaining respondents do not. There is a rough paQern of those states monitoring these three areas and those that do not. The difference in the monitoring of injuries/exposures and deaths might be aQributed to mechanisms for reporting all three to agencies other than the EMS office, while the EMS office may track the laQer for other reasons such as EMS system On Duty Death memorials/other recognition and public safety officer death verification for survivor benefits.
EMS vehicle crashes are reported to be formally monitored in 29 (55%) of responding states and not in 24 (45%). Given the visibility of EMS crashes, established relationships with governor’s highway safety programs, and EMS vehicle licensing responsibilities of many state EMS offices, this monitoring rate may be lower than one might expect.
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EMS FUNDING
In most states, the state EMS office serves as the overall EMS administrative entity with planning, coordination, and leadership responsibilities, as well as a regulatory role for EMS agencies and personnel. It is usually located in a health-related department of state government, though may also be found in a public safety division or independent board structure. The 2016 NASEMSO report Funding Assistance Guide6 provides a detailed description of state EMS office funding sources that may be mentioned in this section.
State Funding Sources
What is the most recent annual budget (in dollars) for the state EMS office from each of the following state sources? - State general fund - State dedicated fund - Ambulance vehicle fees - EMS agency licensure fees - EMS professional licensing fees - Traffic tickets/motor vehicle related fees - Other fees - Private grants/donations - Other state grants/contracts - Other special state funds
Total Funding Amounts by State
Table 60
State Total
Amount
AK $4,067,600 AL $3,570,879 AR $153,000 AS No Response AZ $3,219,700 CA $15,300,000 CO $10,409,600 CT $250,000 DC $220,000
6 h"ps://nasemso.org/nasemso-document/nasemso-funding-assistance-guide-for-state-ems-offices-28mar2016/
State Total
Amount
DE $13,964,566 FL $8,231,430 GA $4,064,637 GU $0 HI $105,673,929 IA $1,172,565 ID $2,523,000 IL $6,491,377 IN $745,935
State Total
Amount KS $2,350,000 KY $2,444,000 LA $868,985 MA $3,940,000 MD $16,202,500 ME $1,287,881 MI $5,850,000 MN $4,874,000 MO $318,216
State Total
Amount MP $0 MS $2,541,423 MT $1,739,100 NC $4,800,000 ND $0 NE $2,710,668 NH $0 NJ $0 NM $800,000
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State Total
Amount
NV $896,581 NY $5,755,000 OH $6,900,000 OK $2,114,431 OR $4,538,710
State Total
Amount
PA No Response PR No Response RI $306,706 SC $5,884,691 SD $422,000
State Total
Amount
TN Unknown TX $3,958,490 UT $3,871,610 VA $144,000,000 VI $4,046,737
State Total
Amount
VT No Response WA $8,940,000 WI $2,271,600 WV $1,329,915 WY $2,000,000
Total Funding Amounts by Sources
Chart 93
5
5
6
8
14
14
14
17
20
34
Other Fees
Other State Grants/Contracts
Private Grants/Donations
Other Special State Funds
EMS Agency Licensure Fees
Traffic Ticket/Motor Vehicle Related Fees
Ambulance Vehicle Fees
State Dedicated Fund
EMS ProfessionalLicensing Fees
State General Fund
COUNT OF STATES
FUNDING
SOURCE
2020 NATIONAL EMS ASSESSMENT – EMS FUNDING
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Table 61
FUNDING SOURCE # States
Receiving Funding
Mean Median Min Max
State General Fund 34 $4,164,347 $1,164,697 $29,000 $83,398,004
State Dedicated Fund 17 $5,619,463 $1,700,000 $59,900 $67,000,000
Ambulance Vehicle Fees 14 $187,082 $55,000 $18,900 $741,423
EMS Agency Licensure Fees 14 $81,217 $55,000 $2,000 $252,300
EMS Professional Licensing Fees 20 $568,478 $186,305 $19,000 $4,595,000
Traffic Tickets/Motor Vehicle Related Fees 14 $8,590,790 $2,859,850 $25,000 $67,000,000
Other Fees 5 $2,028,511 $40,000 $5,000 $10,000,000
Private Grants/Donations 6 $530,058 $425,500 $19,000 $1,035,350
Other State Grants/ Contracts 5 $2,346,093 $93,500 $39,800 $11,267,166
Other Special State Funds 8 $3,861,575 $1,672,278 $50,000 $22,275,925
Analysis
Of those 51 states providing a specific dollar response, 34 (67%) cited state general fund funding, 20 (39%) fees from EMS personnel licensing, and 14 each (27%) fees from EMS vehicle or agency licensing. General fund funding is down 10% from the 2014 funding survey cited above, while funding from EMS licensing fees are comparable. Depending on how states aQributed funds in their answers (duplication is possible), at least 17 (33%) receive dedicated funds from sources other than these as determined by their legislatures, comparable to 2014.
These sources of state funding described in the tables above and below, and in the maps that follow, beg and yet defy interpretation. While most will agree that grant and donations sources are the least dependable year to year, generalities about general fund and dedicated sources are also difficult. While inclusion of a state program in a general fund or dedicated funding source seems the most favorable, the former is subject to across the board cuts in lean state budget years, and the laQer are subject to legislative “raiding” when special project funding is sought. In comparing figures across states or from these 2020 numbers with other years, a mix of funding sources with general and dedicated funding at the core and grant and other fees used for limited projects supplemental funds is probably most desirable.
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STATE GENERAL FUND (n=34)
Table 62
FUNDING SOURCE # States
Receiving Funding
Mean Median Min Max
State General Fund 34 $4,164,347 $1,164,697 $29,000 $83,398,004
Chart 94
Figure 117
3
67
98
1
$29-90k
$115-400k
$500-900k
$1-2 million
$3.3-9.7 million
$83.4million
COUNTOF
STATES
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STATE DEDICATED FUND (n=17)
Table 63
FUNDING SOURCE # States
Receiving Funding
Mean Median Min Max
State Dedicated Fund 17 $5,619,463 $1,700,000 $59,900 $67,000,000
Chart 95
Figure 118
4 4 4 4
1
$59-305k
$525k-1 million
$1.7-2 million
$2.5-5.5 million
$67million
COUNTOF
STATES
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AMBULANCE VEHICLE FEES (n=14)
Table 64
FUNDING SOURCE # States
Receiving Funding
Mean Median Min Max
Ambulance Vehicle Fees 14 $187,082 $55,000 $18,900 $741,423
Chart 96
Figure 119
5 54
$18-40k
$48-70k
$400-750k
COUNTOF
STATES
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EMS AGENCY LICENSURE FEES (n=14)
Table 65
FUNDING SOURCE # States
Receiving Funding
Mean Median Min Max
EMS Agency Licensure Fees 14 $81,217 $55,000 $2,000 $252,300
C O M M E N T S
l MS: Included in Ambulance Vehicle Fees l OK: EMS Agency Licensure Fees
includes Professional Fees and Ambulance Vehicle Fees
Figure 120
56
4
$2-20k
$25-70k
$130-255k
COUNTOF
STATES
Chart 97
2020 NATIONAL EMS ASSESSMENT – EMS FUNDING
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EMS PROFESSIONAL LICENSING FEES (n=20)
Table 66
FUNDING SOURCE # States
Receiving Funding
Mean Median Min Max
EMS Professional Licensing Fees 20 $568,478 $186,305 $19,000 $4,595,000
Chart 98
Figure 121
7
45
2
$19-90k
$110-250k
$300-715k
$2.1 -4.5 million
COUNTOF
STATES
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TRAFFIC TICKETS/MOTOR VEHICLE RELATED FEES (n=14)
Table 67
FUNDING SOURCE # States
Receiving Funding
Mean Median Min Max
Traffic Tickets/Motor Vehicle Related Fees 14 $8,590,790 $2,859,850 $25,000 $67,000,000
C O M M E N T S
l ID: Vehicle registration and driver license fees
Figure 122
1
4 4 4
1
$25k $150-700k
$1.7-4 million
$6.3-15.6 million
$67million
COUNTOF
STATES
Chart 99
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OTHER FEES (n=5)
Table 68
FUNDING SOURCE # States
Receiving Funding
Mean Median Min Max
Other Fees 5 $2,028,511 $40,000 $5,000 $10,000,000
C O M M E N T S
l KY: Training Center and fines l VA: Driver license reinstatement fees,
dedicated to a State Trauma Fund l SC: SC EMS regulates athletic trainers; we
collect fees annually of about $70-75,000
Figure 123
2 2
1
$5-25k
$40-75k
$10million
COUNTOF
STATES
Chart 100
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PRIVATE GRANTS/DONATIONS (n=6)
Table 69
FUNDING SOURCE # States
Receiving Funding
Mean Median Min Max
Private Grants/Donations 6 $530,058 $425,500 $19,000 $1,035,350
Chart 101
Figure 124
1
3
2
$19k $250-500k
$1million
COUNTOF
STATES
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OTHER STATE GRANTS/CONTRACTS (n=5)
Table 70
FUNDING SOURCE # States
Receiving Funding
Mean Median Min Max
Other State Grants/Contracts 5 $2,346,093 $93,500 $39,800 $11,267,166
Chart 102
Figure 125
3
1 1
$39-94k
$250k $11.3million
COUNTOF
STATES
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OTHER SPECIAL STATE FUNDS (n=8)
Table 71
FUNDING SOURCE # States
Receiving Funding
Mean Median Min Max
Other Special State Funds 8 $3,861,575 $1,672,278 $50,000 $22,275,925
C O M M E N T S
l AR: ASP Hwy Grant l AL: Education Trust Fund l DE: DEMRS l HI: EMS Special Fund (includes $7,400,000 in
trauma system special fund) l MN: $683,000 Metro Resource Control
Center; $950,000 Longevity Award Program; $361, 000 Education Reimbursement for volunteers
l VI: Telephone Surcharge Fund
Figure 126
1
2
4
1
$50k $330-550k
$1.3-2.25 million
$22.3million
COUNTOF
STATES
Chart 103
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S T A T E F U N D I N G C O M M E N T S ( G E N E R A L )
l GA: We collect EMS personnel and ambulance license fees, but the ambulance license fee is sent to the Department of Community Health for the indigent care trust fund, and the personnel fees we obtain are sent to the general state fund.
l ID: The EMS Bureau is co-located with the Time Sensitive Emergencies Program, Public Health Preparedness Program, and Idaho’s State Communications Center. Those funds are not included in this report.
l NE: Primary funding is the Fifty Cents for Life. Fund is dwindling and has not kept up with increasing costs.
l NY: We manage approximately $10 million a year in "Aid to Localities" which provides local administrative support to regional councils as well as a statewide EMT training funding.
l OH: Funded by seatbelt fines and related revenues, as well as medical transportation licensing (air medical, ambulance, Mobile ICU, and ambuleQe).
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Federal Funding Sources
What is the most recent annual budget (in dollars) for the state EMS office from each of the following federal sources? - ASPR Emergency Support Functions #8 (ESF8 – Public Health & Medical Services) - ASPR Emergency System for Advance Recognition of Volunteer Health Professionals (ESAR-VHP) - ASPR Hospital Preparedness Program (HPP) - ASPR Medical Reserve Corps (MRC) - ASPR other funds - CDC Preventative Health & Health Services (PHHS) Block Grants - CDC Public Health Emergency Preparedness (PHEP) - DOT NHTSA Highway Safety Grants - FEMA Emergency Management Performance Grant (EMPG) - FEMA Homeland Security Grant Program (HSPG) - FEMA State Homeland Security Program (SHSP) - FEMA Urban Area Security Initiative (UASI) - HRSA EMS for Children (EMSC) State Partnership Grant - HRSA EMSC State Partnership Regionalization of Care Grant - HRSA Office of Rural Health Policy - HRSA Poison Center Support & Enhancement Grant Program - HRSA other - HHS Health Information Technology for Economic and Clinical Health - Other federal funds
Total Funding Amounts by State
Table 72
State Total Amount
AK $572,500 AL $990,000 AR $130,000 AS No Response AZ $840,000 CA $23,818,000 CO $2,147 CT $0 DC $70,000 DE $4,687,305
State Total Amount
FL $652,555 GA $346,690 GU $130,000 HI $760,000 IA $10,054,045 ID $179,000 IL $1,448,636 IN $0 KS $10,000 KY $318,000
State Total Amount
LA $203,836 MA $0 MD $2,905,000 ME $232,084 MI $130,000 MN $130,000 MO $92,000 MP $165,000 MS $102,288 MT $3,473,701
State Total Amount
NC $6,299,088 ND $0 NE $490,000 NH $0 NJ $625,000 NM $380,000 NV $0 NY $130,000 OH $0 OK $0
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State Total Amount
OR $1,330,000 PA No Response PR No Response RI $986,600
State Total Amount
SC $680,000 SD $115,000 TN $0 TX $0
State Total Amount
UT $336,500 VA $130,000 VI $130,000 VT No Response
State Total Amount
WA $0 WI $130,000 WV Unknown WY $1,039,248
Total Funding Amounts by Sources
Chart 104
1
1
1
1
1
1
2
2
2
4
5
9
11
11
13
34
ASPR ESAR-VHP
ASPR MRC
ASPR other funds
FEMA UASI
FEMA SHSP
HRSA EMSC SPROC Grant
FEMA EMPG
HHS Health IT forEconomic and Clinical Health Act
HRSA other
CDC PHEP
HRSA Office of Rural Health Policy
CDC PHHS Block Grants
Other Federal Funds
ASPR HPP
NHTSA Highway Safety Grants
HRSA EMSC State Partnership Grant
COUNT OF STATES
FUNDING
SOURCE
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Table 73
FEDERAL SOURCE # States
Receiving Funding
Mean Median Min Max
ASPR ESF8 0
ASPR ESAR-VHP 1 $44,000
ASPR HPP 11 $1,244,218 $140,100 $25,000 $6,110,088
ASPR MRC 1 $15,000
ASPR Other Funds 1 $1,441,784
CDC PHHS Block Grants 9 $560,379 $236,000 $20,000 $2,960,000
CDC PHEP 4 $1,659,425 $73,542 $11,000 $6,479,614
DOT NHTSA Highway Safety Grant
13 $134,919 $75,000 $15,000 $469,555
FEMA EMPG 2 $101,500 $101,500 $25,000 $178,000
FEMA HSPG 0
FEMA SHSP 1 $250,000
FEMA UASI 1 $2,400,000
HRSA EMSC State Partnership 39 $143,514 $130,000 $130,000 $230,000
HRSA SPROC 1 $200,000
HRSA Office of Rural Health Policy
5 $40,553 $48,000 $10,000 $68,000
HRSA Poison Center 0
HRSA Other 2 $168,700 $168,700 $35,000 $302,400
HHS Health Information Technology
2 $640,000 $640,000 $80,000 $1,200,000
Other Federal Funds 11 $2,488,080 $800,000 $70,000 $17,400,000
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Analysis
The number and variety of federal funding sources used for EMS office programming defy generalization and analysis. These fluctuate with administration and congressional priorities and are generally used for building pieces of EMS systems (e.g. systems of care). The exceptions are the long and strong track record of support by the National Highway Traffic Safety Administration for nationwide program assistance for state EMS priorities, state EMS system assessments, and project support through governor’s highway safety programs, and the Health Resources and Services Administration for EMS for Children program (received by all sates), rural EMS and other state EMS program development funding. The laQer are generally funded through state rural health offices, as well as in some states, through university pediatric medicine and rural health divisions. All generally work closely with state EMS offices. On the increase since 9/11, has been emergency response and health preparedness funding through the Office of the Assistant Secretary for Preparedness and Response (ASPR) in the U.S. Department of Health and Human Services, and various arms of the Department of Homeland Security.
ASPR EMERGENCY SUPPORT FUNCTIONS #8 (ESF8 – PUBLIC HEALTH & MEDICAL SERVICES) No states indicated they receive these funds.
ASPR EMERGENCY SYSTEM FOR ADVANCE RECOGNITION OF VOLUNTEER HEALTH
PROFESSIONALS (ESAR-VHP) (n=1)
Table 74
FEDERAL SOURCE # States
Receiving Funding
Amount
ASPR ESAR-VHP 1 $44,000
Only North Carolina identified receipt of these funds.
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ASPR HOSPITAL PREPAREDNESS PROGRAM (HPP) (n=11)
Table 75
FEDERAL SOURCE # States
Receiving Funding
Mean Median Min Max
ASPR HPP 11 $1,244,218 $140,100 $25,000 $6,110,088
C O M M E N T S
• IL: $118,000 given to the EMSC program to conduct pediatric disaster preparedness initiatives.
Figure 127
2
4 4
1
$25-27.5k
$100-140k
$830k-3.1 million
$6.1million
COUNTOF
STATES
Chart 105
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ASPR MEDICAL RESERVE CORPS (MRC) (n=1)
Table 76
FEDERAL SOURCE # States
Receiving Funding
Amount
ASPR MRC 1 $15,000
Only North Carolina identified receipt of these funds.
ASPR OTHER FUNDS (SPECIFY TYPE) (n=1)
Table 77
FEDERAL SOURCE # States
Receiving Funding
Amount
ASPR Other Funds 1 $1,441,784
Only Delaware identified receipt of these funds (HPP Ebola).
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CDC PREVENTATIVE HEALTH & HEALTH SERVICES (PHHS) BLOCK GRANTS (n=9)
Table 78
FEDERAL SOURCE # States
Receiving Funding
Mean Median Min Max
CDC PHHS Block Grants 9 $560,379 $236,000 $20,000 $2,960,000
Chart 106
Figure 128
3
5
1
$20-90k
$203-630k
$2.9million
COUNTOF
STATES
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CDC PUBLIC HEALTH EMERGENCY PREPAREDNESS (PHEP) (n=4)
Table 79
FEDERAL SOURCE # States
Receiving Funding
Mean Median Min Max
CDC PHEP 4 $1,659,425 $73,542 $11,000 $6,479,614
Chart 107
Figure 129
2
1 1
$11-45k
$102k $6.5million
COUNTOF
STATES
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DOT NHTSA HIGHWAY SAFETY GRANTS (n=13)
Table 80
FEDERAL SOURCE # States
Receiving Funding
Mean Median Min Max
DOT NHTSA Highway Safety Grant 13 $134,919 $75,000 $15,000 $469,555
Chart 108
Figure 130
3
5
23
$15-35k
$56-92k
$121-217k
$350-469k
COUNTOF
STATES
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FEMA EMERGENCY MANAGEMENT PERFORMANCE GRANT (EMPG) (n=2)
Table 81
FEDERAL SOURCE # States
Receiving Funding
Mean Median Min Max
FEMA EMPG 2 $101,500 $101,500 $25,000 $178,000
Figure 131
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FEMA HOMELAND SECURITY GRANT PROGRAM (HSPG) No states indicated they receive these funds.
FEMA STATE HOMELAND SECURITY PROGRAM (SHSP) (n=1)
Table 82
FEDERAL SOURCE # States
Receiving Funding
Amount
FEMA SHSP 1 $250,000
Only Maryland identified receipt of these funds.
FEMA URBAN AREA SECURITY INITIATIVE (UASI) (n=1)
Table 83
FEDERAL SOURCE # States
Receiving Funding
Amount
FEMA UASI 1 $2,400,000
Only Maryland identified receipt of these funds.
2020 NATIONAL EMS ASSESSMENT – EMS FUNDING
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HRSA EMS FOR CHILDREN (EMSC) STATE PARTNERSHIP GRANT (n=39)
Table 84
FEDERAL SOURCE # States
Receiving Funding*
Mean Median Min Max
HRSA EMSC State Partnership 39 $143,514 $130,000 $130,000 $230,000
Chart 109
*All states and territories receive HRSA EMSC State Partnership funding but, in some states, a school of medicine or other state agency receives the grant, not the EMS office. The information included below was verified by the HRSA EMSC Program and reflects the 2018-19 grant cycle. States who received $230,000 were part of a collaborative that provided additional funding to the state program.
Figure 132
33
6
$130k $230k
COUNTOFSTATES
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HRSA EMSC STATE PARTNERSHIP REGIONALIZATION OF CARE (SPROC) GRANT (n=1)
Table 85
FEDERAL SOURCE # States
Receiving Funding
Amount
HRSA SPROC 1 $200,000
Although there were three states with HRSA SPROC grants in 2018-2019, Montana is the only state EMS office who received SPROC funding.
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HRSA OFFICE OF RURAL HEALTH POLICY (n=5)
Table 86
FEDERAL SOURCE # States
Receiving Funding
Mean Median Min Max
HRSA Office of Rural Health Policy 5 $40,553 $48,000 $10,000 $68,000
Chart 110
Figure 133
23
$10-26.5k
$48-68k
COUNTOF
STATES
2020 NATIONAL EMS ASSESSMENT – EMS FUNDING
May 27, 2020 Page 180
HRSA POISON CENTER SUPPORT & ENHANCEMENT GRANT PROGRAM No states indicated they receive these funds
HRSA OTHER (n=2)
Table 87
FEDERAL SOURCE # States
Receiving Funding
Mean Median Min Max
HRSA Other 2 $168,700 $168,700 $35,000 $302,400
Figure 134
2020 NATIONAL EMS ASSESSMENT – EMS FUNDING
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HHS HEALTH INFORMATION TECHNOLOGY FOR ECONOMIC AND CLINICAL HEALTH ACT (n=2)
Table 88
FEDERAL SOURCE # States
Receiving Funding
Mean Median Min Max
HHS Health Information Technology 2 $640,000 $640,000 $80,000 $1,200,000
Figure 135
2020 NATIONAL EMS ASSESSMENT – EMS FUNDING
May 27, 2020 Page 182
OTHER FEDERAL FUNDS (n=11)
Table 89
FEDERAL SOURCE # States
Receiving Funding
Mean Median Min Max
Other Federal Funds 11 $2,733,161 $800,000 $150,000 $17,400,000
Chart 111
Figure 136
2
5
3
1
$70-150k
$575-800k
$1.2-2.7 million
$17.4million
COUNTOF
STATES
2020 NATIONAL EMS ASSESSMENT – EMS FUNDING
May 27, 2020 Page 183
C O M M E N T S
• AL: SAMHSA $800,000 (4-year grant ending in 2021) • AZ: First Responder-Comprehensive Care Act Grant Funds (for Opioid OD Response) from
SAMHSA • CA: Reimbursements from CMS Funding for HITEMS project ($8.9 Million), Poison Control
System Title 19 ($7.7 million), and Poison Control System Title 21 ($800,000) • DC: $70,000 from CDC emergency opioid grant • DE: $1,557,244 (Public Health Crisis Response); $538,001 (First Responder-SAMHSA) • IA: Opioid FR-CARA $798,200 • IL: Approximately $1.2 million is going to be given to EMS to fund the trauma registry. • MT: CDC DDPI Opioid $540,000, CDC Opioid Crisis $1,965,263, CDC NVDRS $195,175 • RI: CARA – $800,000 • SC: CDC and STR grants
F E D E R A L F U N D I N G C O M M E N T S ( G E N E R A L )
l MA: Funding is not shared easily between departments. l NE: Highway safety grants are on a requested basis for travel to conferences, not part of
operational budget. Other funds are the Medicaid 90/10 HiTech funding. l OK: OSDH receives federal funds detailed above, but they are allocated to our Emergency
Preparedness Division, not to the EMS Division. l TX: The EMS office gets no federal funds for the state EMS office, but the statewide EMS system
does get funds from Federal sources, just not through the state EMS office.
2020 NATIONAL EMS ASSESSMENT – EMS D ISASTER PREPAREDNESS
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EMS DISASTER PREPAREDNESS
Federal Disaster and Public Health Preparedness Program Par ticipation
For the listed federal disaster and public health preparedness programs, please indicate state EMS office participation in the following program areas:7 - ASPR Emergency Support Functions #8 (ESF8– Public Health & Medical Service) - ASPR Emergency System for Advance Registration of Volunteer Health Professionals (ESAR-VHP) - ASPR Hospital Preparedness Program (HPP) - ASPR Medical Reserve Corps (MRC) - CDC Public Health Emergency Preparedness Program (PHEP) Cooperative Agreement - FEMA Homeland Security Grant Program (HSGP)
Chart 112
7 The original question from the survey asked for states to “indicate the level of state EMS office participation” with the following options: co-located in the same organization; leadership; coordination and planning; operational role; do not participate. The first four options were grouped into “Participate” for the purpose of simplification.
31
15
30
16
24
7
22
38
23
37
29
46
FEMA HSGP(n=53)
CDC PHEP(n=53)
ASPR MRC(n=53)
ASPR HPP(n=53)
ASPR ESAR-VHP(n=53)
ASPR ESF8(n=53)
FEMA HSGP(n=53)
CDC PHEP(n=53)
ASPR MRC(n=53)
ASPR HPP(n=53)
ASPR ESAR-VHP
(n=53)
ASPR ESF8(n=53)
Participate 22 38 23 37 29 46Do Not Partipcate 31 15 30 16 24 7
2020 NATIONAL EMS ASSESSMENT – EMS D ISASTER PREPAREDNESS
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ASPR EMERGENCY SUPPORT FUNCTIONS #8 (ESF8 – PUBLIC HEALTH & MEDICAL SERVICES) (n=53)
Figure 137
Figure 138
87%
of states participate, at some level, in ESF8. (n=46)
2020 NATIONAL EMS ASSESSMENT – EMS D ISASTER PREPAREDNESS
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ASPR EMERGENCY SYSTEM FOR ADVANCE REGISTRATION OF VOLUNTEER HEALTH
PROFESSIONALS (ESAR-VHP) (n=53)
Figure 139
Figure 140
55%
of states participate, at some level, in ESAR-VHP. (n=29)
2020 NATIONAL EMS ASSESSMENT – EMS D ISASTER PREPAREDNESS
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ASPR HOSPITAL PREPAREDNESS PROGRAM (HPP) (n=53)
Figure 141
Figure 142
70%
of states participate, at some level, in HPP. (n=37)
2020 NATIONAL EMS ASSESSMENT – EMS D ISASTER PREPAREDNESS
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ASPR MEDICAL RESERVE CORPS (MRC) (n=53)
Figure 143
Figure 144
43%
of states participate, at some level, in MRC. (n=23)
2020 NATIONAL EMS ASSESSMENT – EMS D ISASTER PREPAREDNESS
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CDC PUBLIC HEALTH EMERGENCY PREPAREDNESS PROGRAM (PHEP) COOPERATIVE
AGREEMENT (n=53)
Figure 145
Figure 146
72%
of states participate, at some level, in PHEP. (n=38)
2020 NATIONAL EMS ASSESSMENT – EMS D ISASTER PREPAREDNESS
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FEMA HOMELAND SECURITY GRANT PROGRAM (HSGP) (n=53)
Figure 147
Figure 148
42%
of states participate, at some level, in HSGP. (n=22)
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Exercises/Drills and Real Events
Mass Casualty (n=54)
Did the state EMS office participate in, or does it expect to, a mass casualty exercise(s)/drill(s) in 2018 or 2019?
Figure 149
Figure 150
85%
of states participated in, or planned, a drill/ exercise in 2018-2019. (n=45)
2020 NATIONAL EMS ASSESSMENT – EMS D ISASTER PREPAREDNESS
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Mass Casualty – Pediatric Considerations & Family Reunification (n=54)
Did, or will, the drill(s)/exercise(s) include pediatric considerations, to include family reunification?
Figure 151
Figure 152
of states who held (or planned) a drill/exercise included pediatric considerations. (n=25)
56%
2020 NATIONAL EMS ASSESSMENT – EMS D ISASTER PREPAREDNESS
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Exercises and Drills (n=53)
How many of the following exercises/drills did (or will) the state EMS office participate in during 2018 or 2019?
Chart 113
C O M M E N T S ( O T H E R )
l DE: 2 Symposium l MA: 3 hospital strikes l ND: 2 Mass fatality l NJ: Our EMS Task Force is a quasi-state program
and participates at most large-scale events l VI: 2 Support of fire personnel in structural fire
drill
7
8
14
14
16
19
25
31
32
Other
High-yield Explosive
Chemical
Crowd Event
Transportation Event
Radiological
Active Shooter
Natural Disaster
Biological
45 states (85%) indicated participation in at least one drill or exercise in 2018/2019
Figure 153
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Real Events (n=53)
How many of the following real events did the state EMS office participate in during 2018?
Chart 114
C O M M E N T S ( O T H E R )
l IL: 6 (1 fire, 1 power outage and 4 bomb threats) l NH: 1 gas leak l WV: Many (as a state entity we participate in EOC
operations if state of emergency is enacted)
1
5
6
9
9
11
12
12
36
High-yield Explosive
Other
Radiological
Chemical
Transportation Event
Crowd Event
Biological
Active Shooter
Natural Disaster
COUNT OF STATES
EVENT
TYPE
43 states (81%) indicated participation in at least one real event in 2018.
Figure 154
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Analysis
State EMS offices generally participate in responses to events such as these by heading EMS in state emergency operations centers and, in longer duration events, providing coordination personnel at local emergency operations centers and incident sites. These events were sufficiently significant in size or duration to enable that level of participation.
The following considers the correlation, if any between real incidents that occurred in 2018 and anticipation of, or subsequent preparation for, those events according to the types of events for which drills/exercises had been held or planned. Unknown is how often a 2018 real event was preceded by a drill/exercise or was followed by a drill/exercise.
CHEMICAL Nine states had real events. Of those, 5 states (56%) did not have (or have planned) a drill/exercise.
BIOLOGICAL (INCLUDING HIGH CONSEQUENCE INFECTIOUS DISEASE) Twelve states had real events. Of those, only 1 state (8%) did not have (or have planned) a drill/exercise.
RADIOLOGICAL Six states had real events. All of those states had (or planned) a drill/exercise.
HIGH-YIELD EXPLOSIVE One state had real events (there were two); and they had two drills/Exercises.
ACTIVE SHOOTER Twelve states had real events. Of those, only one state (8%) did not have (or have planned) a drill/exercise.
TRANSPORTATION EVENT Nine states had real events. Of those, only one state (11%) did not have (or have planned) a drill/exercise.
CROWD EVENT Eleven states had real events. Of those, five (45%) states did not have (or have planned) a drill/exercise.
NATURAL DISASTER Thirty-six states had real events. Of those, eight states (22%) did not have (or have planned) a drill/exercise.
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Mass Casualty Event Protocols (n=54)
Do EMS-specific mass casualty event protocols exist for use by local EMS agencies?
Figure 155
Chart 115
67
02
12
15
2
10
Mandatory Mandatory -Process toModify
Mandatory -Process to
Develop Own
Regional County/Local Model Other No Protocols
COUNTOF
STATES
PROTOCOL TYPE
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C O M M E N T S ( O T H E R )
l NH: Combination State Protocols and Fire Mobilization Plan l CO: Each local agency has patient care protocols but agencies in some areas of the state have
common medical direction and use county or regional protocols.
Analysis
Forty-four states (81%) have mass casualty protocols and ten (19%) do not. The most common practice is to provide model protocols or to accept the use of regional/local protocols (29 states or 54%). Fourteen states (26%) have statewide protocols that are mandatory to some degree. The more large-scale incidents that occur, the likelier that multiple jurisdictions will be involved and the less tenable will become differing local and regional mass casualty management protocols.
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Triage Systems
REQUIRE USE OF STATEWIDE TRIAGE SYSTEM (n=54)
Does your state require the use of a specific statewide triage system?
Figure 156
Chart 116
6
10
52
7
24
Yes -START
Yes - START/JumpSTART
Yes -SALT
Yes -Other
No - Local Decision(EMS OfficeApproves)
No -Local Decision
COUNTOF
STATES
TRIAGE REQUIREMENT
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C O M M E N T S
l Other ¡ CT: SMART ¡ TN: SMART
l Local Decision ¡ NV: Suggest SMART or START ¡ WI: Not required; State EMS Board has adopted position of MUCC-compliant program, and
we’re working on timeframe for implementation.
Analysis
Thirty-one states (57%) allow locales to establish patient triage mechanisms, while 23 others (43%) require standardization of the process used if not a single process. The more large-scale incidents that occur, the likelier that multiple jurisdictions will be involved and the less tenable will become the existence of differing local triage decision and patient condition designation mechanisms.
2020 NATIONAL EMS ASSESSMENT – EMS D ISASTER PREPAREDNESS
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EMERGENCY RESPONSE PLAN (n=30)
Does your state emergency response plan document suggest a specific triage system for the local decisions?
Only states who responded “Local Decision” or “Local Decision, but EMS approves” to the question above (Require Use of Statewide Triage System), answered this question. “White” states below (“N/A”) are all others. One state did not respond.
Figure 157
Chart 117
0
2
4
5
19
Yes - Other
Yes - SALT
Yes - START/Jump
Yes - START
No
COUNT OF STATES
TRIAGE
SYSTEM
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TYPE OF MASS CASUALTY TAG (n=54)
Which mass casualty incident triage tag colors do your state’s EMS professionals use?
Figure 158
1
4
5
44
Red-yellow-green-white-black
Red-yellow-green-gray-black
Unknown
Red-yellow-green-black
COUNT OF STATES
TRIAGE
COLOR
TAG
Chart 118
of state’s EMS professionals use red-yellow-green- black triage tags.
81% Figure 159
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PROVIDE TRIAGE TAGS (n=54)
Does your state EMS office provide triage tags to EMS agencies free of charge?
Figure 160
Figure 161
of states do not provide triage tags to EMS agencies free of charge.
(n=37)
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May 27, 2020 Page 203
C O M M E N T S
l AZ: Triage tags are purchased at the local level (state EMS nor BPHEP provide tags). l IN: We initially supplied all transporting agencies with SMART tags. l MN: Funded and distributed by 8 regional programs throughout the State of Minnesota. l NH: This will be a discontinued practice. l NV: Initially; they have to purchase after. l OH: No specific state funding, however, EMS agencies may use EMS training and equipment
grant funds to purchase triage tags. l VI: The state is the primary response agency. All other agencies supporting medical in those
instances would fall under the command of the State agency who would distribute those tags.
2020 NATIONAL EMS ASSESSMENT – EMS D ISASTER PREPAREDNESS
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of states have an electronic patient care tracking system (statewide, regional, or local).
Figure 163
Electronic Patient Tracking Systems
USE OF PATIENT TRACKING SYSTEMS (n=54)
Are electronic prehospital patient tracking system(s) in use?
Figure 162
4
8
14
28
Yes - Regional
Yes - Local
Yes -Statewide
No
COUNT OF STATES
Chart 119
2020 NATIONAL EMS ASSESSMENT – EMS D ISASTER PREPAREDNESS
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WHICH PATIENT TRACKING SYSTEM (n=14)
Which patient tracking system does your state use?
This question was only asked to those who responded “Yes, Statewide” to question above (Use of Patient Tracking Systems).
C O M M E N T S
l AL: Acute Health Systems and Head and Spinal Registry l DC: GER l DE: ImageTrend l MI: EM Track l MN: MNTrac l MS: Knowledge Center l NC: Disaster Medical System l ND: HC Standards l NE: ImageTrend HavBed System transitioning to Knowledge Center l NM: eTeam/redi-op l OH: OHTRAC l OK: OKEMSIS l PA: Knowledge Center l RI: State developed PTS system
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OASIS COMPLIANCE (n=14)
Is the patient tracking system OASIS standard-compliant for tracking emergency patient (TEP) software?
This was only asked to those who responded “Yes, Statewide” to question above (Use of Patient Tracking Systems).
Figure 164
Chart 120
Yes1
7%
No5
36%
Don't Know
857%
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Analysis
Electronic patient tracking system products became available over a decade ago. As grant funding facilitated their spread, it became evident that these products were not interoperable when more than one was used at a mass casualty event. NASEMSO, the Department of Homeland Security (USDHS), and the OASIS standards development organization developed standards (Tracking Emergency Patients or TEP) to mitigate this problem. Despite these efforts over a decade, product incompatibility and lack of vendor adoption of these standards create potential complications during triage, treatment and transport. The previous three questions demonstrate that while 48% of states have electronic patient tracking systems, nearly half of those are local/regional systems susceptible to a lack of standards. There is significant confusion about what standards exist, though they are enforced for current federal grant purposes by USDHS SafeCom grant requirements.
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APPENDIX A – ASSESSMENT INSTRUMENT
Final – Monday, March 25, 2019 1
2020 National EMS Assessment Survey Workbook
Welcome to the 2020 National EMS Assessment The general instructions were in the invitation to participate that got you here. So, just a few words of guidance:
To guarantee your work is saved and submitted, we recommend that you complete the online survey in one sitting, therefore you received a workbook to use to gather the information from your colleagues before starting the survey online. If you do have to leave before completion, you must return to the same computer to access the survey where you left off.
Please note that due to skip logic within the SurveyMonkey tool, the question numbers in this document may not reflect the same question numbers in SurveyMonkey.
Definitions: License: We use the term “license” and its variants. A “license” and “licensure” represents legal authority granted to an individual, agency, vehicle or other entity/thing by the state to perform, or with which to perform, certain restricted activities. This authority granted by the state is defined as licensure in this survey, acknowledging that some states still use “certification”, “permitting” and perhaps other terms to describe the same granting of authority.
EMS Professional: The term “EMS professional” is intended to mean anyone, volunteer or career, with an official EMS capacity to interact with patients and others within the EMS system and generally outside of healthcare facilities.
Community Paramedicine: The term “community paramedicine” is used in the context of EMS resources being used to meet non-emergency health care needs in a community. For the survey’s purpose, it includes mobile integrated healthcare, community EMS, community EMT, and other such names and services that may be found in the state.
Final – Monday, March 25, 2019 2
In case we have follow‐up questions, please tell us…
1) Name, job title, phone, and email of the person completing this assessment:
Name:
Job Title:
Phone:
Email:
EMS Organizations
2) What types of EMS agencies operate in your state, and who regulates them? (count of agencies that are based in your state)
EMS office regulates
Other state agency
regulates
Operate in the state but not
regulated
Do not operate in the
state
{a} 911 response (scene) with transport
Comments:
{b}911 response (scene) without transport
Comments:
{c} Ground specialty care services (e.g. interfacility, critical care, other transport)
Comments:
{d} Air medical services
Comments:
{e} Non-ambulance medical transport (e.g. wheelchair vans/ambulettes)
Comments:
{f} Community paramedicine-type
Comments:
{g} Emergency medical dispatch (EMD) center
Comments:
Final – Monday, March 25, 2019 3
3) How many of the following agencies are currently licensed in your state? (indicate numbers for each type listed, with the understanding that an agency may be counted more than once if multiple licenses held) {a} 911 response (scene) with transport
{b} 911 response (scene) without transport {c} Ground specialty care services (e.g. interfacility, critical care, other transport) {d} Air medical services {e} Non-ambulance medical transport (e.g. wheelchair vans/ambulettes) {f} Community paramedicine-type {g} Emergency medical dispatch (EMD) center
4) How many of the following types of vehicles operate in your state, whether your office regulates them or not? (count of vehicles that are based in your state) {a} 911 response (scene) with transport {b} 911 response (scene) without transport {c} Ground specialty care services (e.g. interfacility, critical care, other transport) {d} Air medical services (rotor-wing) {e} Air medical services (fixed wing) {f} Non-ambulance medical transport (e.g. wheelchair vans/ambulettes) {g} Community paramedicine-type
5) Indicate how many EMS agencies are currently licensed in your state for each of the following service levels: {a} Emergency medical responder {b} Emergency medical technician {c} Advanced emergency medical technician
{d} Other level between emergency medical technician and paramedic {e} Paramedic
{f} Above or in addition to paramedic (e.g. a specialty license or endorsement) {g} Agencies not licensed by level/type of care (Please explain: )
EMS Professionals 6) Indicate how many of the following EMS professionals are licensed in your state:
Emergency medical responder Emergency medical technician Advanced emergency medical technician Other level between emergency medical technician and paramedic Paramedic Above or in addition to paramedic (e.g. a specialty license or endorsement) Emergency medical dispatcher (or 911 telecommunicators with EMD ability)
Final – Monday, March 25, 2019 4
7) Indicate how many of each of the following types of EMS medical director positions exist within your state: (count of positions, since one medical director may hold multiple positions, enter “0” if no position(s) exist)
Local agency level EMS region/jurisdiction level State level
Comments:
8) Approximately what percentage of EMS professionals fit within the following age groups? <20 years 20-29 years 30-39 years 40-49 years 50-59 years 60-69 years 70-79 years 80-89 years >89 years
Unknown
9) Approximately what percentage of EMS professionals identify with the following race groups? American Indian or Alaska Native Asian, Black, or African American White Another race
Unknown
10) Approximately what percentage of EMS professionals are: Male Female Other Unknown
11) When and how are criminal background checks performed? (select all that apply) Self-declaration or local law enforcement endorsement only, for all purposes Background check for initial licensing using state information only Background check for initial licensing using state/federal information Background check for relicensing using state information only Background check for relicensing using state/federal information No background check required
Comments:
Final – Monday, March 25, 2019 5
EMS Communications
12) What percentage of EMS agencies in your state use video to transmit patient, or other information, to health care providers for telehealth/telemedicine consultation?
0% 1-10% 11-25% 26-50% 51-75% 76-99% 100% Unknown
13) How many EMS agencies in your state routinely receive electronic patient-specific medical history information from another healthcare entity (e.g. hospital, health information exchange) for use during the patient’s EMS care (i.e. in real-time)?
None Some Less than half Approximately half More than half All Unknown
14) How many EMS agencies in your state routinely send the electronic patient care report (ePCR) to another healthcare entity or provider (e.g. hospital, alternate destination) as a part of the EMS communication/notification in advance of the patient’s arrival (i.e. in real-time)?
None Some Less than half Approximately half More than half All Unknown
EMS Responses and Patient Care 15) In 2018, how many EMS agency responses were there in your state? (enter unknown when applicable)
911 response (scene) 911 response (scene) – Pediatric only (ages 0-18) Stand-by or other community/public safety support
Final – Monday, March 25, 2019 6
Ground specialty care (e.g. interfacility, critical care, other transport) Air medical services Non-ambulance medical transports (e.g. wheelchair vans/ambulettes) Community paramedicine-type Cannot estimate number of responses by type—estimated total number of agency responses Comments:
16) In 2018, how many estimated EMS patient transports were there in your state? From scene to emergency department From scene destination other than emergency department Between facilities Cannot estimate number of EMS transports by type/destination—estimated total number of transports Comments:
17) How has your state implemented EMS patient care protocols? Mandatory statewide protocols – must be used by all EMS providers, unchanged Mandatory statewide protocols – must be used by all EMS providers, but there is a process for services to petition the state to modify them
Mandatory statewide protocols – must be used by all EMS providers, but there is a process for services to petition the state to develop and use their own protocols
Model – have model statewide protocols for providers, but each service or region may choose to use these protocols or may develop their own protocols
Regional – have regional protocols that must be followed by all services within the region and cover a geographic area that includes multiple services (e.g. county or multicounty regions)
Local – each EMS service or agency develops its own protocols Other (Describe)
18) Does your state maintain a list of: Yes, all levels Yes, ALS only No
Medications EMS professionals are permitted to administer?
Procedures EMS professionals are permitted to perform?
19) Does your state require pediatric-specific safe transport devices to be carried on ambulances? No Yes (please quote the requirement)
Final – Monday, March 25, 2019 7
EMS Data, NEMSIS, and Benchmarking
20) How does the state acquire EMS response and patient care data from the following agency types?
Submission required through
regulation/law (includes effective
enforcement provisions)
Submission required through
regulation/law (with no effective
enforcement provisions)
Submission not required through
regulation/law, but highly
encouraged/ enabled to
submit
No requirements,
but plan to require
submission in the next few
years
No plans to require
submission in the near future
911 response (scene) with transport
Other requirement (please explain)
911 response (scene) without transport
Other requirement (please explain)
Ground specialty care services (e.g. interfacility, critical care, other transport)
Other requirement (please explain)
Air medical services
Other requirement (please explain)
Emergency medical dispatch (EMD) center
Other requirement (please explain)
21) Which versions of NEMSIS is your state collecting? Indicate approximate percentage of total annual records collected in 2018 for each version selected, if unknown, please indicate in the comments box for that version.
Yes, we do collect/accept this version
No, we do not collect/accept this version
Version 2
% of total annual records collected in 2018
Version 3.3.4
% of total annual records collected in 2018
Final – Monday, March 25, 2019 8
Yes, we do collect/accept this version
No, we do not collect/accept this version
Version 3.4.0
% of total annual records collected in 2018
Other (please include explanation in comments box to the right)
% of total annual records collected in 2018 & provide specifics about the version
22) When does your state plan to be completely transitioned to v3.4.0? Transition complete December 2019 December 2020 December 2021 December 2022 December 2023 Beyond December 2023 Unknown (please explain)
23) What approximate percentage of your total 2018 agency response records were submitted to your state’s ePCR database?
0% 1-25% 26-50% 51%-75% 76%-99% 100% We cannot estimate call volume, percentage unknown
24) What approximate percentage of your state’s 2018 calls were/will be sent to NEMSIS? 0% 1-25% 26-50% 51%-75% 76%-99% 100% We cannot track call volume, percentage unknown
25) How frequently after the EMS event are agencies required to submit data to the state? No regulated submission timeframe requirement
Final – Monday, March 25, 2019 9
Within 24 hours Within 7 days Within 30 days Within 1 year Other (please specify)
26) Which of the following healthcare-related data systems are operationally linked to/with your EMS data system? (select all that apply)
Motor vehicle crash system Traffic records system Health information exchange Emergency department Hospital discharge database Trauma registry Stroke registry STEMI registry Medical examiners Vital statistics (death certificates) None Other (please specify)
27) If you have additional comments as they relate to linking data with other systems, please provide them here:
28) To which of the following does your state routinely make available or supply EMS data? (select all that apply)
State department of transportation State department of highway safety State law enforcement agency State or local health information exchange Regulatory agency for hospitals None Other (please identify)
29) If you have additional comments as they relate to providing data to other agencies/organizations, please provide them here:
30) Does your state EMS patient care reporting data system provide data and/or analytics in order to participate in a public health surveillance system used to monitor for public health outbreaks or acts of terrorism?
Yes Go to #31
Final – Monday, March 25, 2019 10
No Skip to #34
31) Which of the following sources are used to participate in public health surveillance? (select all that apply)
Biospatial dashboard ePCR system dashboard (please identity in question #32) Homegrown system (e.g. university, epidemiology division/department) NEMSIS dashboards Overdose Detection Mapping Application Program (ODMAP) Cardiac Arrest Registry to Enhance Survival (CARES) American Heart Association (AHA) Get With The Guidelines (GWTG) Other (please identify)
32) If you indicated that you use an ePCR system dashboard, which vendor do you use? Digital Innovation EMS Performance Improvement Center ESO Solutions ImageTrend Intermedix ZOLL Other (please specify)
33) If you have additional comments as they relate to providing data to public health surveillance/dashboards, please provide them here:
34) Does your state’s data system provide benchmarking capabilities between:
Yes No
EMS agencies?
Counties?
States?
Other? (please specify)
35) If your state does not already provide benchmarking capabilities between states, do you have a desire to participate in such activities?
Yes No
Comments:
36) Does the state’s EMS data system include EMS Compass-based performance measurement indicators? Yes
Final – Monday, March 25, 2019 11
No
37) Does the state EMS office use EMS Compass indicators in measuring state-level system performance? Yes No
38) If you have comments as they relate to EMS Compass, please provide them here:
EMS Workforce Health & Safety
39) Does your state recommend any particular health/wellness programs for EMS professionals? Yes No
Comments:
40) Do all EMS agencies have access to a critical incident stress management resource? Yes No
Comments:
41) Does your state monitor (in any formal way): Yes No
On the job EMS injuries?
On the job EMS blood borne pathogen exposures?
On the job EMS deaths?
EMS vehicle crashes?
EMS Funding
42) What is the most recent annual budget (in dollars) for the state EMS office from each of the following state sources? (enter $0 if the funding source isn't part of the annual budget) State general fund State dedicated fund Ambulance vehicle fees EMS agency licensure fees EMS professional licensing fees Traffic tickets/motor vehicle related fees Other fees (specify type) Private grants/donations
Final – Monday, March 25, 2019 12
Other state grants/contracts (specify type) Other special state funds (specify type)
43) If you have additional comments as they relate to state funding sources, please provide them here:
44) What is the most recent annual budget (in dollars) for the state EMS office from each of the following federal sources? (enter $0 if the funding source isn't part of the annual budget) ASPR Emergency Support Functions #8 (ESF8 – Public Health & Medical Services) ASPR Emergency System for Advance Recognition of Volunteer Health Professionals (ESAR-VHP) ASPR Hospital Preparedness Program (HPP) ASPR Medical Reserve Corps (MRC) ASPR other funds (specify type) CDC Preventative Health & Health Services (PHHS) Block Grants CDC Public Health Emergency Preparedness (PHEP) DOT NHTSA Highway Safety Grants FEMA Emergency Management Performance Grant (EMPG) FEMA Homeland Security Grant Program (HSPG) FEMA State Homeland Security Program (SHSP) FEMA Urban Area Security Initiative (UASI) HRSA EMS for Children (EMSC) State Partnership Grant HRSA EMSC State Partnership Regionalization of Care (SPROC) Grant HRSA Office of Rural Health Policy HRSA Poison Center Support & Enhancement Grant Program HRSA other (specify type) HHS Health Information Technology for Economic and Clinical Health Act Other federal funds (specify type)
45) If you have additional comments as they relate to federal funding sources, please provide them here:
EMS Disaster Preparedness
46) For the listed federal disaster and public health preparedness programs, please indicate the level of state EMS office participation in the following program areas: (select all that apply for each program)
Final – Monday, March 25, 2019 13
Co‐located in the same
organization Leadership
Coordination and
planning
Operational role
Do not participate
ASPR Emergency Support Functions #8 (ESF8 – Public Health & Medical Services)
ASPR Emergency System for Advance Registration of Volunteer Health Professionals (ESAR-VHP)
ASPR Hospital Preparedness Program (HPP)
ASPR Medical Reserve Corps (MRC)
CDC Public Health Emergency Preparedness Program (PHEP) Cooperative Agreement
FEMA Homeland Security Grant Program (HSGP)
47) Did the state EMS office participate in, or does it expect to, a mass casualty exercise(s)/drill(s) in 2018 or 2019?
Yes, in 2018 or early 2019 Go to #48 Yes, planning for later 2019 Go to #48 No Skip to #51
48) Did, or will, the drill(s)/exercise(s) include pediatric considerations? Yes (please indicate how many ) Go to 49 Too early in the planning process to know Skip to 50 No Skip to 50
49) How many of the exercise(s)/drill(s) with pediatric considerations included, or will include, a family reunification component?
50) How many of the following exercises/drills did (or will) the state EMS office participate in during 2018 or 2019? Chemical Biological (including high consequence infectious disease) Radiological High-yield explosive Active shooter
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Transportation event Crowd event Natural disaster Other (identify type)
51) How many of the following real events did the state EMS office participate in during 2018? Chemical Biological (including high consequence infectious disease) Radiological High-yield explosive Active shooter Transportation event Crowd event Natural disaster Other (please specify)
52) Do EMS-specific mass casualty event protocols exist for use by local EMS agencies? No Yes, mandatory statewide protocols – must be used by all EMS providers, unchanged Yes, mandatory statewide protocols – must be used by all EMS providers, but there is a process for
services to petition the state to modify them Yes, mandatory statewide protocols – must be used by all EMS providers, but there is a process for
services to petition the state to develop and use their own protocols Yes, Model – have model statewide protocols for providers, but each service or region may choose to
use these protocols or may develop their own protocols Yes, regional – have regional protocols that must be followed by all services within the region and cover
a geographic area that includes multiple services (e.g. county or multicounty regions) Yes, local – each EMS service or agency develops its own protocols Other (please describe)
53) If you have additional comments as they relate to mass casualty event protocols, please provide them here:
54) Does your state require the use of a specific statewide triage system? (select one) No, local decision Go to #55 No, local decision but state EMS office approves tool Go to #55 Yes, SALT (MUCC compliant) Skip to #56 Yes, START Skip to #56 Yes, START/JumpSTART Skip to #56 Yes, other (please specify) Skip to #56
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55) Does your state emergency response plan document suggest a specific triage system for the local decisions?
No Yes, SALT (MUCC compliant) Yes, START Yes, START/JumpSTART Yes, other (please specify)
56) Which mass casualty incident triage tag colors do your state’s EMS professionals use? (select all that apply)
Red-yellow-green-black Red-yellow-green-gray-black Red-yellow-green-white-black Other (please specify) Unknown
57) Does your state EMS office provide triage tags to EMS agencies free of charge? Yes No
Comments
58) Are electronic prehospital patient tracking system(s) in use? Yes, statewide Go to #59 Yes, regional Skip to #61 Yes, local Skip to #61 No Skip to #61
59) Which patient tracking system does your state use?
60) Is the patient tracking system OASIS standard-compliant for tracking emergency patient (TEP) software? Yes No Don’t know
61) Would your state be willing to participate in a research study to compare the various triage systems that are available, in addition to exploring their applicability and/or effectiveness in the response to various scenarios?
Yes Yes, if there is funding dedicated for the research No
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